Aim: To study the renal resistive index (RI) and pulsatility index (PI) measured by renalDoppler in various stages of liver cirrhosis and their values to detect cirrhotic patients at risk for developing the hepatorenal syndrome
Methods: This study included 60 cirrhotic patients divided into 4 groups (15 patients each):compensated liver cirrhosis (group A) , diuretic responsive ascites (group B), refractoryascites (group C) , hepatorenal syndrome (group D) and ten healthy persons as the controlgroup (E). All patients were subjected to detailed history taking and clinical examination.Laboratory investigations included simple urine analysis, complete blood picture, liver functiontests, blood urea and serum creatinine, serum sodium and serum potassium, 24-hoururine collection for sodium concentration, creatinine concentration and protein concentration.Ultrasonographic examination and renal duplex Doppler ultrasonography were undertakento assess the RI and PI
Results: The RI of both interlobar and arcuate arteries was significantly higher in all patientgroups than in the control group (p‹0.01). The RI was significantly higher in patients withrefractory ascites than in patients with diuretic responsive ascites, and also in patients withdiuretic responsive ascites than in patients with compensated cirrhosis (p‹0.01); in patientswith hepatorenal syndrome than in patients with diuretic responsive ascites and patientswith compensated cirrhosis (p‹0.0001). The PI was significantly higher in all patients groupsthan in the control group (p‹0.01) and in patients with refractory ascites than in patients withdiuretic responsive ascites and was also higher in patients with responsive ascites than inpatients with compensated cirrhosis (p‹0.0001). Also, the PI was significantly higher in patientswith hepatorenal syndrome than in patients with responsive ascites and patients withcompensated cirrhosis (p‹0.0001). Creatinine clearance in patients with the hepatorenalsyndrome was significantly lower than that of other different groups (p<0.0001) but there wasno significant change in creatinine clearance between patients with compensated cirrhosisand control group. While creatinine clearance in patients with diuretic responsive asciteswas significantly higher than that in patients with compensated cirrhosis (p<0.05) there wasno significant change between patients with diuretic responsive ascites and patients withrefractory ascites
Conclusion: Both renal resistive index and pulsatility index increase with the degree of hepaticdecompensation. Renal duplex ultrasound which is a non-invasive, simple and easy methodto study intrarenal hemodynamics in patients with liver cirrhosis may predict patients at riskof hepatorenal impairment.