Abstract
Background: Liver cirrhosis patients are complicated by different pathological processes leading to increased mortality and morbidity among them. Renal hemodynamic alteration leads to development of hepatorenal syndrome. Renal arterial Doppler study can be an effective screening modality for liver cirrhosis patients. Resistivity and Pusatility indices are parameters measured b renal Doppler which reflects renovascular impedance. There is good correlation between these parameters and severity of liver cirrhosis assessed by Child-Pugh scoring system.
Materials and Methods: This study included 50 cirrhotic patients divided into three groups according to Child-Pugh classification, and fifteen healthy controls. All the patients were subjected to clinical, laboratory and ultrasound evaluation to confirm the diagnosis of cirrhosis. The renal arterial duplex ultrasound examination was conducted on patients as well as controls to measure Pusatility and Resistivity index in main, segmental and cortical renal arteries.
Results: Pusatility and Resistivity index were found to be elevated in the patients of Child class B and C as compared to class A and controls in the main and segmental renal arteries. Both indices were highest in class C than B. The Child class A and controls were not showing statistically significant difference in the main and segmental renal arteries. Resistivity index of the cortical arteries showed significant difference with that of controls. Both Pusatility and Resistivity indices were highest in class C than B and A in cortical arteries. Oesophageal varices also showed significant correlation to elevated Pusatility and Resistivity indices in relation to Child classes.
Conclusion: Both renal Pusatility and Resistive index increase with the degree of the severity of the liver cirrhosis assessed by Child-Pugh classification. Renal duplex ultrasound is a safe, non-invasive and effective screening modality to study the renal hemodynamics and may predict renal dysfunction in different stages of the liver cirrhosis.
References
- Fouad YM, Mokarrab H, Elgebaly AF, El-Amin H, Abdel-Raheem EM, Sharawy MA, et al. Renal duplex Doppler ultrasound in patients with HCV related liver cirrhosis. Trop Gastroenterol Off J Dig Dis Found. 2009 Dec;30(4):213–8.
- Ahn HS, Kim YS, Kim SG, Kim HK, Min SK, Jeong SW, et al. Cystatin C is a good predictor of hepatorenal syndrome and survival in patients with cirrhosis who have normal serum creatinine levels. Hepatogastroenterology. 2012 Jun;59 (116):1168–73.
- Cholongitas E, Shusang V, Marelli L, Nair D, Thomas M, Patch D, et al. Review article: renal function assessment in cirrhosis – difficulties and alternative measurements. Aliment Pharmacol Ther. 2007;26(7):969–78.
- Cardenas A, Arroyo V. Renal and circulatory dysfunction in liver cirrhosis. Pathogenesis and treatment. Ann Gastroenterol [Internet]. 2007 Mar 25 [cited 2013 Jul 28];14(3). Available from: http://www.annalsgastro.gr/index.php/annalsgastro/article/view/81
- Koda M, Murawaki Y, Kawasaki H. Renovascular resistance assessed by color Doppler ultrasonography in patients with chronic liver diseases. J Gastroenterol Hepatol. 2000 Dec;15(12):1424–9.
- Schelling JR, Linas SL. Hepatorenal syndrome. Semin Nephrol. 1990 Nov;10 (6):565–70.
- Rowe I, Neuberger J. Prognostic models in cirrhosis: an aid but not a replacement for clinical judgement. Liver Int. 2007;27(5):595–7.
- Ginès A, Escorsell A, Ginès P, Saló J, Jiménez W, Inglada L, et al. Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gastroenterology. 1993 Jul;105(1):229–36.
- Popov D, Krasteva R, Ivanova R, Mateva L, Krastev Z. Doppler parameters of hepatic and renal hemodynamics in patients with liver cirrhosis. Int J Nephrol. 2012;2012:961654.
- Knapp R, Plötzeneder A, Frauscher F, Helweg G, Judmaier W, zur Nedden D, et al. Variability of Doppler parameters in the healthy kidney: an anatomic-physiologic correlation. J Ultrasound Med Off J Am Inst Ultrasound Med. 1995 Jun;14(6):427–9.
- Platt JF, Ellis JH, Rubin JM, Merion RM, Lucey MR. Renal duplex doppler ultrasonography: A noninvasive predictor of kidney dysfunction and hepatorenal failure in liver disease. Hepatology. 1994;20(2):362–9.
- Fouad YM, Mokarrab H, Elgebaly AF, El-Amin H, Abdel-Raheem EM, Sharawy MA, et al. Renal duplex Doppler ultrasound in patients with HCV related liver cirrhosis. Trop Gastroenterol Off J Dig Dis Found. 2009 Dec;30(4):213–8.
- Maroto A, Ginès A, Saló J, Clària J, Ginès P, Anibarro L, et al. Diagnosis of functional kidney failure of cirrhosis with Doppler sonography: prognostic value of resistive index. Hepatol Baltim Md. 1994 Oct;20(4 Pt 1):839–44.
- Koda M, Murawaki Y, Kawasaki H. Renovascular resistance assessed by color Doppler ultrasonography in patients with chronic liver diseases. J Gastroenterol Hepatol. 2000 Dec;15(12):1424–9.
- Rivolta R, Maggi A, Cazzaniga M, Castagnone D, Panzeri A, Solenghi D, et al. Reduction of renal cortical blood flow assessed by doppler in cirrhotic patients with refractory ascites. Hepatology. 1998;28(5):1235–40.
- Wang Y, Liu L-P, Bai W-Y, Wen S-B, Dan H-J, Luan Y-Y, et al. Renal haemodynamics in patients with liver cirrhosis assessed by colour ultrasonography. J Int Med Res. 2011;39(1):249–55.
- Colli A, Fraquelli M, Pometta R, Cocciolo M, Visentin S, Conte D. Renovascular Impedance and Esophageal Varices in Patients with Child-Pugh Class A Cirrhosis1. Radiology. 2001 Jun 1;219(3):712–5.
- Brkljacić B, Mrzljak V, Drinković I, Soldo D, Sabljar-Matovinović M, Hebrang A. Renal vascular resistance in diabetic nephropathy: duplex Doppler US evaluation. Radiology. 1994 Aug;192(2):549–54.
- De Haan MW, Kroon AA, Flobbe K, Kessels AGH, Tordoir JH, van Engelshoven JMA, et al. Renovascular disease in patients with hypertension: detection with duplex ultrasound. J Hum Hypertens. 2002 Jul;16(7):501–7.
Corresponding Author
Dr Tejaswi Chalumuri MD (RD)
Department of Radio-Diagnosis, Andhra Medical College, Visakhapatnam, India
DOI: https://dx.doi.org/10.18535/jmscr/v7i11.57
