Title: The Role of Renal Resistive Index in Assessing the Early Renal Dysfunction of Cirrhosis

Authors: Dr Nivethitha Karthika L, Dr Riyaz Ahmed S, Dr Samai P, Dr Akshiitha Ramesh, Dr Manivel, Dr Seena CR, Dr Kulasekaran N

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i6.182

Abstract

Background: Hyperdynamic circulatory state in cirrhosis leads to splanchnic vasodilatation and renal vasoconstriction in that leads to the development of hepatorenal syndrome (HRS).

Aim:  To measure the intrarenal resistive index in patients with and without ascites and compare the value of RI with Child Pugh and MELD scoring systems.

Methods: 100 patients with cirrhosis liver were selected for the study. Bilirubin, INR and serum creatinine were measured and patients were subjected to sonographic evaluation of abdomen followed by Doppler Ultrasound of both kidneys and RI values were obtained. Linear regression analysis was used between RI and MELD that showed significant correlation.

Results:  71 patients had RI > 0.7 (0.7 kept as cut-off value)

29 patients had RI < 0.7

Patients with severe ascites had more RI than the patients with absent or mild to moderate ascites and had significant comparability with CTP scoring and MELD scoring systems.

Conclusion: Value of RI was higher in patients with cirrhosis and comparable prognostic value with MELD and CTP scoring system.

Key Words: Hepatorenal syndrome, cirrhosis, MELD, CTP, Child Pugh Score, Renal resistive index.

References

1.      Bell H, Jahnsen J, Kittang E, Raknerud N, Sandvik L: Long-term prognosis of patients with alcoholic liver cirrhosis: a 15-year follow-up study of 100 Norwegian patients admitted to one unit. Scand J Gastroenterol

2.      Gines A , Escorsell A , Gines P et al. Incidence, predictivefactors, and prognosis of the hepatorenal syndrome incirrhosis with ascites . Gastroenterology 1993 ; 105: 229 – 236 .

3.      Ginès A, Escorsell A, Ginès P, Salo J, Jiménez W, Inglada L, Navasa M, Claria J, Rimola A, Arroyo V, Rodés J: Incidence, predictive factors and prognosis of the hepatorenal syndrome. Gastroenterology 1993;105:229–236.

4.      Arroyo V, Fernandez J, Gin?s P: Pathogenesis and treatment of hepatorenal syndrome.  Semin Liver Dis  2008; 28:81-95

5.      Zeller T, Bonvini RF, Sixt S: Color-coded duplex ultrasound for diagnosis of renal artery stenosis and as follow-up examin-ation after revascularization. Catheter Cardiovasc Interv 2008;71:995–999.

6.      Chudek J, Kolonko A, Krol R, Ziaja J, Cierpka L, Wiecek A: The intrarenal vascular resistance parameters measured by duplex Doppler ultrasound shortly after kidney transplantation in patients with immediate, slow, and delayed graft function

7.      Götzberger M, Kaiser C, Landauer N, Dieterle C, Heldwein W, Schiemann U: Intrarenal resistance index for the assessment of early renal function impairment in patients with liver cirrhosis. Eur J Med Res 2008;13: 383–387. 11

8.      Sacerdoti A, Bolognesi M, Merkel C, Angeli P, Gatta A: Renal vasoconstriction in cirrhosis evaluated by duplex Doppler ultrasonography. Hepatology 1993; 17: 219–224 12

9.      Colli A, Cocciolo M, Riva C, Martinez E: Abnormal renovascular impedance in patients with hepatic cirrhosis: detection with duplex US. Radiologie1993;187:561–563. 13

10.  Celebi H, Dönder E, Celiker H: Renal blood flow detection with Doppler Ultrasonography in patients with hepatic cirrhosis. Arch Intern Med 1997;157:564–567

11.  Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, D'Amico G, Dickson ER, Kim WR (2001). "A model to predict survival in patients with end-stage liver disease".  Hepatology 33 (2): 464–70.

12.  Kamath PS, Kim WR (March 2007). "The model for end-stage liver disease (MELD)". Hepatology 45 (3):

13.  Wiesner et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology (2003) vol. 124 (1) pp. 91-6

14.  M. A. Papadakis and A. I. Arieff, “Unpredictability of clinical evaluation of renal function in cirrhosis. Prospective study,” The American Journal of Medicine, vol 82, no 5, pp 945–952, 1987. 

15.  L. Caregaro, F. Menon, P. Angeli et al., “Limitations of serum creatinine level and creatini.ne clearance as filtration markers in cirrhosis,” Archives of Internal Medic-ine, vol. 154, no. 2, pp. 201–205, 1994.

16.  Radermacher J, Ellis S, Haller H. Renal resistance index and progression of renal disease. Hypertension 2002; 39:699–703.

Corresponding Author

Dr Nivethitha Karthika L

Senior Resident, Department of General Medicine,

Saveetha Medical College and Hospital, Saveetha Nagar, Thandalam, Chennai – 602105