Study of Resistive Index in Various Stages of Liver Cirrhosis and Its Significance in Calculating the Risk for Hepatorenal Syndrome

Purpose To describe the relationship between renal artery resistance index (RARI) and liver function based on Child‐Pugh system among patients with liver cirrhosis (LC) in Southwest Nigeria. Methods About 50 patients with LC and 50 controls were consecutively recruited into this prospective comparative case control study. Each LC patient was classed based on Child‐Turcotte‐Pugh (CTP) system after relevant tests. Subjects underwent abdominal ultrasonography with triplex Doppler examination of the right kidney to obtain RARI. Results About 50 cirrhotic and 50 controls completed the study. Age range of cirrhotic subjects was 19‐69 years (mean ± SD = 47.5 ± 13.3) while that of controls was 18‐69 years (46.9 ± 15.0). RARI was higher (P = <.001) in patients with LC (0.68) than in controls (0.57). RARI was also significantly higher (P = <.001) in cirrhotic subjects in CTP class C (0.72) than in those in classes B (0.66) and A (0.58). Additionally, RARI showed significant correlation with CTP total score (r = .662; P = <.001), serum bilirubin (r = .297; P = .036), serum albumin (r = −.494; P = <.001), serum sodium (r = −.369; P = .008), Model for End Stage Liver Disease (MELD) score (r = .316; P = .026) and MELD‐Na score (r = .470; P = .001). RARI showed no significant relationship with serum creatinine (r = .110; P = .445) and blood urea nitrogen (r = .112; P = .437). Conclusion Liver cirrhosis is associated with renovascular changes which manifest as increased resistance in the renal arteries. RARI is a useful noninvasive tool for the assessment of these changes and should be done routinely in the evaluation of patients with LC.

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Renal arterial resistance index among subjects with liver cirrhosis in a Nigerian population

Onwuka

Ayoola

Adekanle

et al. 2021

J of Clinical Ultrasound

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Impact of Propranolol on Preventing Renal Dysfunction in Patients with Cirrhosis

Rezayat

Zeraati

Rad

et al. 2017

Middle East J Dig Dis

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BACKGROUND One of the earliest diagnostic signs of hepatorenal syndrome in patients suffering from liver cirrhosis is an increase in the renal vascular resistive index (RI). In this study, the impact of propranolol on decreasing this index and to postpone the probability of hepatorenal syndrome has been investigated. METHODS In the current research, 30 patients with liver cirrhosis with different age and sexes have been enrolled. Demographic data and complete medical history have been collected using a specific questionnaire. At first, renal artery Doppler ultrasonography was performed to determine the RI. The patients were then treated with propranolol, and under supervision, the dose of the drug was increased gradually every 3 to 5 days to reach the target of 25% decrease in resting heart rate. One month after reaching the target dose of the medicine, Doppler ultrasonography was repeated for the patients and the second RI was compared with the pretreatment ones. RESULTS According to our results after treatment with propranolol, a significant decrease of RI was observed ( p < 0.01). However, there was no significant difference in the glomerular filtration rate (GFR) before and after treatment with propranolol ( p = 0.290). In our study, we found that administering propranolol was associated with significant changes in RI and GFR between the patients with compensated and decompensated cirrhosis (mean change: -0.005 ± 0.017 vs. -0.058 ± 0.045; p < 0.01 for RI and -4.226 ± 17.440 vs. 13.486 ± 12.047; p < 0.01 for GFR in patients with compensated and decompensated cirrhosis, respectively). CONCLUSION Propranolol reduces renal vascular RI in patients with cirrhosis. The response rates in the patients with decompensating cirrhosis were significantly higher than the patients with compensating cirrhosis

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The Role of Renal Resistive Index in Assessment of Functional Renal Impairment in Patients with Liver Cirrhosis

EL-Lehleh

Mageed

et al. 2017

Afro-Egyptian Journal of Infectious and Endemic Diseases

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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.

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Study of Resistive Index in Various Stages of Liver Cirrhosis and Its Significance in Calculating the Risk for Hepatorenal Syndrome

Cited by 3 publications

References 15 publications

Renal arterial resistance index among subjects with liver cirrhosis in a Nigerian population

Renal arterial resistance index among subjects with liver cirrhosis in a Nigerian population

Impact of Propranolol on Preventing Renal Dysfunction in Patients with Cirrhosis

The Role of Renal Resistive Index in Assessment of Functional Renal Impairment in Patients with Liver Cirrhosis

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