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Background and study aim: Renal dysfunction often develops in patients with liver cirrhosis. Hepatorenal syndrome (HRS) represents the end-stage of reduction in renal perfusion. Duplex Doppler ultrasonography of the kidneys is a noninvasive method to assess blood flow and arterial vascular resistance as a parameter for vasoconstriction. This study aimed to assess the role of renal resistive index as a non-invasive marker for early detection of functional renal impairment in patients with liver cirrhosis. Patients and Methods: This study was conducted on 20 patients with liver cirrhosis without ascites vs. 60 patients with liver cirrhosis and ascites and 20 healthy subjects as control group. Patients and control were subjected to complete blood picture, liver and kidney functions, serum electrolytes, twenty four hours urinary sodium, abdominal ultrasonography and duplex Doppler evaluation of the renal arteries with calculation of mean renal RI. Results: Highly significant difference between cirrhotic patients with ascites and cirrhotic patients without ascites and controls regarding mean renal resistive index for both kidneys (P<0.001). At Cutoff point of renal RI 0.71, the sensitivity, specificity and accuracy to predict HRS were 100%, 80% and 82% respectively with AUC= 0.997. A statistical high significant positive correlation between RI and serum creatinine, child class, MELD score and MELD-Na (r=0. 0.818, r= 0. 0.539, r= 0.739 r= 0.807 respectively and P<0.001). A statistical high significant negative correlation between RI and serum sodium, 24 hours urinary sodium, and platelets (r=-0.778, r= 0.-0.688, r=-0.422 respectively and P<0.001). Conclusion: Renal duplex Doppler ultrasound is useful as a non-invasive method for the evaluation of the renal hemodynamic changes in cirrhotic patients and can predict HRS.

Background and study aim:Hepatocellular carcinoma (HCC) is the fifth most common neoplasm in the world, and the third most common cause of cancerrelated death. Golgi protein 73 is normally expressed in epithelial cells of many human tissues. GP73 expression is upregulated in hepatocytes, and in serum from patients with hepatitis and liver cirrhosis regardless the etiology. This work aimed to study the diagnostic role of serum Golgi protein 73level as a marker for HCC. Patients and methods:This study was conducted on 48 patients with HCC on top of liver cirrhosis (GI), 20 patients with liver cirrhosis (GII), and 20 healthy controls (GIII). Patient and controls were subjected to careful medical history, full clinical examination and laboratory investigations including CBC, ESR, liver function tests, renal function tests, viral markers, serum AFP and Serum Golgi protein 73 by ELISA. Results:Serum GP73 showed highly significant increase (with P value <0.001) in HCC group X±SD (1765.92±747.99) in comparison with cirrhoticX±SD (772.45±73.84) and control X±SD (458.30±103.03) groups, also significantly increased in cirrhotic group in comparison with control group. There was significant increase in mean values of serum GP73 in patients with HCC associated with portal vein thrombosis or lymph node enlargement also there was significant positive correlationbetween GP73 and tumor size. In diagnosis of HCC, at cut off point 55 ng/ml, AFP had sensitivity 81.3% and specificity 70.0%, and Gp73 at cut off point 847.5 ng/l, the sensitivity was 93.8% and specificity 90.0%. With combined use of AFP and Gp73: the sensitivity of diagnosis of HCC increased to 95.8%. Conclusion:Significant increase in sensitivity, accuracy and negative predictive value with combined use of AFP and Gp73 than AFP alone in diagnosis of HCC.

Background and study aim: Irrespective of etiology, liver cirrhosis together with its complications can affect other body organs and lead to a great morbidity and mortality. In Cirrhotic patients, Sarcopenia block normal life activities. Low serum testosterone has been reported in up to 90% of men with liver cirrhosis. This study aimed to assess the correlation between serum testosterone level and sarcopenia in Egyptian male patients with liver cirrhosis. Patients and Methods: This prospective study included sixty cirrhotic males. Three groups were designed according to Child-Pugh classification. Twenty healthy males were included as control group. Patients and controls were subjected to complete blood picture, liver and kidney functions. Serum total & free testosterone was analyzed by specific enzyme-linked immunosorbent assay (ELISA) kit and Skeletal Muscle Index (L3 SMI) was assessed by CT scan. Results: There was significant decrease in serum levels of free and total testosterone in cirrhotic patients than controls, with lowest levels in child C cirrhotic males (p value <0.001). 32 (53.3%) cirrhotic patients were sarcopenic ‫‬. ‫‬ At cutoff point 14.1 nmol/L total testosterone level has Sensitivity 91%, Specificity 94% and Accuracy 93.0% to predict sarcopenia in cirrhotic males with AUC = 0.938. There was significant positive correlation between total testosterone level and the L3 SMI (r= 0.819, P<0.001). In addition, a positive correlation was detected between total testosterone and hemoglobin (r= 0.668, P<0.001), serum Na (r= 0.846, P<0.001) and Platelet count (r= 0.904, P<0.001), also negative correlation with MELD score (r=-0.928, P<0.001). Conclusion: Significant positive correlation between total testosterone level and Skeletal Muscle Index (L3 SMI) and low testosterone level is associated with sarcopenia in cirrhotic males.