Doppler Sonography of the Kidney in Patients with Liver Cirrhosis : Prognostic Value of Resistive Index

You, Jong Hyun; Cho, Yong Kyun; Jun, Kyung Hong; Rhee, Young Rae; Park, Chang Young; Kim, Byoung Ik; Kim, Hyang; Chung, Eul Soon; Lee, Sang Jong

Abstract

Rackground/Aims: Kidney dysfunction in cirrhosis is a well recognized complication that often appears to develop abruptly in previously nonazotemic patients. Intrarenal vasoconstriction is an early hallmark of this functional renal failure because elevatecl serum creatinine is a late feature of the hepatorenal syndrorne. Resistive index (RI) is the most widely used for estimation of intrarenal arteriolar vascular resistance. We have applied renal duplex Doppler ultrasonography to identify this early renal vasoconstriction in nonazotemic patients with liver cirrhosis.
METHODS
We prospectively measured Rl, kidney and liver function and plasma level of renin activity, aldosterone and antidiuretic hormone in 12 healthy subjects, 13 cirrhotic patients without ascites, 22 cirrhotic patients with ascites, 7 cirrhotic patients with ascites and renal falure. Tnen, patiens were followed for 6 months. The incidence of renal failure in each groups were recored and ccrrelated with RI, liver and renal function.
RESULTS
Rl was significantly increased in patients with cirrhosis (0.68 0.06) comparecl with healthy subjects (0.39t0.04). In 42 cirrhotic patients, it was significantly increased in patients with ascites (0.69 -0.05) compared with patients without a.;cites (0.64+0.05) and correlated significantly to creatinine clearance (Cr=-0.61, p0.05). RI was significantly increased in patients with intractable ascites (0.72 0.04) compared with diuretics responded ascites (0.68+0.05). Kidney dysfunction subsequently developed in six (37%) of 16., who had an clevated RI. (= 0.70) In contrast, only one (4/o) of 26 patients with a normal Rl had kidney dysfunction.
CONCLUSIONS
Renal duplex Doppler ultrasonography can identify high risk group for subsequen1 development of renal dysfunction and be useful for treatrqent of ascites in cirrhotic patients with nonazotemia by detecting renal vasoconstriction.