Diagnosis of Kidney Failure of Cirrhosis Patients with Doppler Sonography

Yi, Sun Young; Back, Seung Yon

Abstract

BACKGROUND/AIMS: Kidney dysfunction, a well-recognised cornplication of established liver disease, is characterized by early renal hemodynamic changes(vasoconstriction) that was formerely clinically recognized as kidney disease. Resistive index(RI) is time-velocity wave-form analysis of Doppler signals from smal] arteriolar resistance. To investigate whether the RI is useful in the diagnosis of kidney failure and prediction of survival of cirrhotic patients with ascites.
METHODS
We obtained Rl by Doppler sonography, and conducted chemical tests of kidney and liver function. The plasma level of renin, aldosterone, and antidiuretic hormone was obtained frorn 8 healthy subjects and 29 patients with cirrhosis with or without ascites. A total of 18 clinical and laboratory variables were analyzed for prognostic value.
RESULTS
Five variables were correlated with liver function status inc]uding, BUN, creatinine, GFR, plasma renin activity and antidiuretic hormone(P<0.01). RI was significantly increased in patient with Child-Pugh class C group(Group II1) compared with Child-Pugh class A or B group(Group II) and healthy subject group(Group l)(P=0.01, P=0.001). And RI was correlated inverse]y with glomerular filtration rate. Also RI was significantly increased in patients with ascites compared to patients without ascites (P=0.001). The sensitivity and specificity of the RI in detecting kidney failure in patients with ascites were 77% and 79%, respectively.
CONCLUSIONS
RI is a sensitive method to assess intrarenal hemodynamics in patients with cirrhosis and ascites. It also has a predictive value for survival of these patients.