Clinical value of contrast-enhanced ultrasonography in evaluating renal cortical perfusion in elderly diabetic patients / 中华老年医学杂志

Objective To investigate the clinical value of contrast-enhanced ultrasonography (CEUS)in evaluating renal cortical perfusion in elderly diabetic patients.Methods A retrospective cross-sectional study was conducted.A total of 70 diabetic patients with chronic renal insufficiency stage 1 to 5 were enrolled.The glomerular filtration rate (GFR)was estimated according to the creatinine level.Based on GFR,patients were divided into a mild-to-moderate chronic kidney disease (CKD)group(n=42,CKD stage 1 to 3)and a severe CKD group(n=28,CKD stage 4 to 5).All patients underwent CEUS for the assessment of renal perfusion and renal dynamic imaging for the assessment of GFR.QLAB analysis software was used to obtain the time-intensity curve(TIC)and related parameters including area under the curve(AUC),the ascending slope(A),the derived peak intensity(DP1) and the time to peak (TTP).The differences in renal perfusion parameters were compared between the two groups.Pearson correlation test was used to assess the correlation between the quantitative parameters of renal cortical perfusion and GFR.Results There was no significant difference in age,gender,history of hypertension,basal blood glucose level,systolic or diastolic blood pressure between the two groups (all P ＞ 0.05).CEUS findings revealed high renal cortical blood perfusion in the mild-to-moderate group.There were significant differences in quantitative perfusion parameters including AUC,DPI,A and TTP between the two groups.Pearson correlation test indicated that TTP and A were significantly correlated with GFR in both groups(r =-0.456 and-0.693,0.432 and-0.529,all P＜0.05),while AUC and DPI had no correlation with GFR(r =-0.003 and -0.057,0.066 and-0.081,all P ＞0.05).Conclusions Diabetic patients with mild-to-moderate CKD have high renal cortical blood perfusion.CEUS findings can indirectly reflect renal function.The perfusion parameters A and TTP have good correlations with GFR.CEUS can be used as a safe and effective method to evaluate renal function,especially in patients with severe renal insufficiency,but more studies are needed to verify the results.

Renal Blood Perfusion During Resuscitation After Hemorrhagic Shock: A Quantitative Analysis on Animals by Contrast-enhanced Ultrasound / 中国医学影像学杂志

Pttrpose Contrast-enhanced ultrasound (CEUS) is a noninvasive technique that can monitor the blood perfusion of organs.The study aims to discuss the value of CEUS in quantitative analysis of renal microcirculation during resuscitation after hemorrhagic shock (HS).Materials and Methods Forty healthy New Zealand white rabbits were randomly divided into five groups in this prospective study.One group was selected as normal control group (T1),the other four groups were established HS model by using the modified Wiggers's method;one of the four HS groups was taken as shock group (T2),and the other three HS groups were named as 2 h group (T3),6 h group (T4),and 24 h group (T5) according to resuscitation time.CEUS was used to observe the rabbits' renal perfusion and the perfusion parameters were recorded including amplitude of peak intensity (A),time to peak (TTP),area under curve (AUC) and curve rising slope rate (Grad);the correlation of these parameters with histological examination was analyzed.Results Compared with T1 group,The TTP ofT2 group prolonged and the A,AUC and Grad decreased (P＜0.05);the HS model was established successfully.Compared with T2 group,the A,AUC and Grad of T3,T4 groups increased (P＜0.05),but the TTP of T3,T4 groups was not shortened (P＞0.05).The above parameters were all significantly different between T5 group and T2 group (P＜0.05),but the differences did not exist between T5 and T1 groups (P＞0.05),which indicated that the perfusion parameters gradually returned to normal level after resuscitation.The histological staining demonstrated that the renal tubular epithelial cell swelling and vascular congestion gradually restored after resuscitation.Conclusion CEUS can quantitatively assess renal perfusion changes during resuscitation as a noninvasive monitor.

Ultrasound monitoring the renal blood flow during extracorporeal membrane oxygenation / 中国医师杂志

Objective To investigate the utilization of ultrasound monitoring the renal blood flow during extracorporeal membrane oxygenation (ECMO).Methods Twentry one cases,who received veinartery ECMO for heart failure,were examinated by bed-side ultrasound before the ECMO initiated,right after the ECMO initiated,each day after the ECMO initiated,and right after the ECMO weaned.The renal interlobar artery peak velocity (Vmax) was measured,and the renal interlobar artery resistant index (RI) was calculated,as well as the values of the serum creatinine (SCr) and blood urea nitrogen (BUN) were recorded.All the data were compared.Results Compared to the variables right after the ECMO initiated,thc Vmax incrcascd (P ＜ 0.05) two days after ECMO initiated and right after the ECMO weaned,while RI (P ＜ 0.05),SCr (P ＜ 0.05) and BUN (P ＜ 0.05) decreased,there being significant differences (P ＜ 0.05).Conclusions While treating patients with extracorporeal membrane oxygenation,the ultrasound can monitoring the renal blood flow effectively,and provide important parameters for the clinical doctors as the basis of the diagnosis and treatment.

Influence of chlorpromazine on renal histology of rats submitted to ischemia and reperfusion injury

ABSTRACT PURPOSE: To analyze the influence of chlorpromazine on renal histology of rats submitted to ischemia and reperfusion injury. METHODS: Sixteen Wistar rats - split in two groups - have been used: control group, receiving 3 mg/kg isotonic saline solution through caudal vein, and, the chlorpromazine group, receiving 3 mg/kg-IV of such medication. The nephrectomy of the left kidney lower third was carried out; immediately, the test-drug was administrated. After 15 minutes of test-drug administration, the renal pedicle was clamped; in 60 minutes of ischemia it was released. After 24 hours of the renal reperfusion, the rats were, once more, anesthetized and submitted to total left nephrectomy, and, afterwards, to euthanasia. Histological findings regarding ischemia have been evaluated and compared between the groups. RESULTS: There was no statistical difference related to inferior renal pole histological analysis. Regarding 60-minute renal ischemia, chlorpromazine has statistically reduced the accrual of leucocytes within the vasa recta renis (p=0.036) and the congestion of peritubular capillaries (p=0.041). When conducting joint analysis of histological patterns, the control group showed a median score of 11 and chlorpromazine group of 5.5 (p=0.036). CONCLUSION: Chlorpromazine significantly reduced the occurrence of secondary damage to ischemia and reperfusion process in the overall histological analysis.

Dose-response Relationship of SonoVue and Contrast-enhanced Ultrasound:An Experimental Study in Healthy Rabbits / 中国医学影像学杂志

Purpose To study the effects of different doses of ultrasound contrast agent SonoVue upon contrast-enhanced ultrasound (CEUS) in the kidney of healthy rabbits, and to seek the optimal dose of SonoVue. Materials and Methods CEUS was performed in 10 healthy rabbits with GE LOGIQ-E9 by using 8 different doses of SonoVue (ranging from 0.02 ml/kg to 0.16 ml/kg). The quantitative parameters of the time-intensity curve (TIC) were measured and statistically compared. Results The TICs showed that the peak intensity (PI) and the area under curve (AUC) increased with dose when the doses ranged from 0.02 ml/kg to 0.10 ml/kg (r=0.962 and 0.965, P<0.05); when the dose further increased, AUC had little change but PI decreased reversely. The arrival time (AT) shortened along with the increase of the SonoVue dose (r= - 0.917, P<0.05). The dose had a positive correlation with time to peak (r=0.49, P<0.05). Conclusion The parameters of TIC are influenced intensely by different doses of SonoVue. It is important to realize the relationship between SonoVue doses and its effects upon contrast-enhancement ultrasound in microcirculatory quantification. The dose of 0.10 ml/kg appears to be the optimal dose for CEUS in examining kidney of healthy rabbit.

Determinantes precoces en el desarrollo de injuria renal aguda durante la sepsis abdominal experimental / Early determinants of acute kidney injury during experimental intra-abdominal sepsis

Background: Sepsis-induced acute kidney injury (AKI) is an early and frequent organ dysfunction, associated with increased mortality. Aim: To evaluate the impact of macrohemodynamic and microcirculatory changes on renal function and histology during an experimental model of intra-abdominal sepsis. Material and Methods: In 18 anaesthetized pigs, catheters were installed to measure hemodynamic parameters in the carotid, right renal and pulmonary arteries. After baseline assessment and stabilization, animals were randomly divided to receive and intra-abdominal infusion of autologous feces or saline. Animals were observed for 18 hours thereafter. Results: In all septic animals, serum lactate levels increased, but only eight developed AKI (66%). These animals had higher creatinine and interleukin-6 levels, lower inulin and para-aminohippurate clearance (decreased glomerular filtration and renal plasma flow), and a negative lactate uptake. Septic animals with AKI had lower values of mean end arterial pressure, renal blood flow and kidney perfusion pressure, with an associated increase in kidney oxygen extraction. No tubular necrosis was observed in kidney histology. Conclusions: The reduction in renal blood flow and renal perfusion pressure were the main mechanisms associated with AKI, but were not associated with necrosis. Probably other mechanisms, such as microcirculatory vasoconstriction and inflammation also contributes to AKI development.

Effects of small dose of dopamine on renal blood flow in elderly patients undergoing cardiac valve replacement under cardiopulmonary bypass / 中华麻醉学杂志

Objective To evaluate the effects of small dose of dopamine on the renal blood flow in the elderly patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB).Methods Sixty elderly patients,of ASA physical status Ⅱ or Ⅲ,aged 65-74 yr,weighing 52-77 kg,scheduled for elective cardiac valve replacement under CPB,were randomized to receive either normal saline (group C,n =30) or dopamine (group D,n =30).After beginning of surgery,CPB was established routinely.In group D,dopamine was continuously infused for 20 min at a rate of 2 μg· kg-1 · min-1 starting from 10 min after the hearts were perfused with cardioplegic solution for the first time,while the equal volume of normal saline was given in group C.The left renal blood flow velocity was measured by transesophageal echocardiography and mean arterial pressure was recorded before and after dopamine infusion.Blood samples were obtained before surgery and at 24 h after surgery for determination of blood urea nitrogen concentrations.Results Blood urea nitrogen concentrations were significantly increased at 24 h after surgery than that before surgery in the two groups.There was no significant difference in mean arterial pressure and the left renal blood flow velocity before and after dopamine infusion between the two groups.Conclusion Small dose of dopamine (2 μg· kg-1· min-1) dose not increase the renal blood flow or improve the postoperative renal function in the elderly patients undergoing cardiac valve replacement under CPB.

Renal protective effect and its related mechanisms of targeted abdominal perfusion pressure treatment in intra-abdominal hypertension / 国际外科学杂志

Objective To evaluate the renal protective effect of targeted abdominal perfusion pressure (APP) treatment in intra-abdominal hypertension (IAH) and further investigate its related mechanisms.Methods Twelve healthy pigs were randomly divided into experimental group and control group,each group had 6 pigs.All animals were collected urine volume each hour,continuously monitored mean arterial pressure (MAP) and renal cortical blood flow after anesthesia.IAH models were established by intraperitoneally injecting carbon dioxide in all animals,the baseline MAP,intra-abdominal pressure (IAP)and APP were obtained before IAH models established.In both groups,IAP was raised gradually from 0 mm Hg to 10 mm Hg,20 mm Hg and 30 mm Hg.In control group,IAP was maintained at 30 mm Hg for 8 hours with-out any other interventions.In experimental group,the animals were intravenously given with norepinephrine in order to get a target level of APP equal to its baseline values after 15 minutes of the onset of 30 mm Hg IAP.Changes of renal cortical blood flow,serum creatinine,TNF-α,IL-6 and urine IL-18 with the alteration of IAP in both groups were explored.Animals were then sacrificed for renal histopathology after 8 hours of the onset of 30 mm Hg IAP.Results With the increase of IAP,renal cortical blood flow in both groups was significantly decreased (P ＜ 0.01).Compared to its baseline,serum Cr and urinary IL-18 were significantly up-regulated after the maintenance of IAP at 30 mm Hg for 6 hours in both groups (P ＜ 0.05).However,in experimental group,which utilized a strategy of targeted APP,significant improvement of the renal cortical blood flow was observed (P ＜ 0.01),and urinary IL-18 was significantly lower than the control group (P ＜ 0.05).Renal histopathological examination found no obvious abnormalities either in control group or in experimental group.Conclusions The targeted APP treatment may have some renal protective function within the first 8 hours of IAH by improving renal cortical blood flow rather than affecting systemic inflammatory response.

Effects of acute hypervolemic hemodilution and intra-operative cell salvage on orthopedic surgery patients / 中华创伤杂志

Objective To evaluate impacts of acute hypervolemic hemodilution (AHH) and intra-operative cell salvage (ICS) with 6％ volume fraction of hydroxyethyl starch (HES) on hemodynamics,blood saving efficiency and renal function of orthopedic surgery patients.Methods A total of 58 patients from orthopedic surgery were involved and randomly divided into AHH + ICS group (30 cases) and control group (28 cases).Changes of hemodynamic indices (HR,MAP and CVP) and renal function indices (BUN,BCr,UCr and ALB) in both groups were compared before operation (T0),immediately after operation (T1) and at postoperative 4 hours (T2),1 day (T3) and 2 days (T4).CCr was counted and intraoperative blood conservation was observed at each time point as well.Results HR,MAP and CVP of the two groups had no significant differences.Both groups showed some drop of HR (P ＜ 0.05),but an increase of MAP and CVP at T1-T4 (P ＜ 0.05),in contrast with levels at TO.BUN,BCr and ALB also showed insignificant differences between groups or within group at each time point.CCr in the control group showed no significant difference at each time point.On the contrary,CCr in the AHH + ICS group had a fall at T1-T4 and was declined to the lowest level at T2.CCr in the AHH + ICS group showed a recovery at T3-T4 and its level at T4 was still lower than that at TO,with no significant difference.CCr in the two groups showed insignificant difference at TO,but its level in the AHH + ICS group was lower than that in the control group at T1-T4,at T2 in particular (P ＜0.01).Moreover,CCr in the two groups was still significantly different at T4 (P ＜ 0.05).Renal function indices of the two groups were all within normal range at each time point.Intraoperative blood loss and unrine volume of the two groups had no significant differences,but intraoperative fluid requirement,allogenic blood transfusion volume and transfusion rate of AHH + ICS group were notably lower than those of control group (P ＜ 0.05 or P ＜0.01).Conclusions AHH plus ICS using HES are safe,effective and promising integrated blood conservation measures,which significantly reduces intraoperative allogenic blood transfusion volume and transfusion rate and has few impacts on fundamental vital signs and renal function.However,prolonged use of large dose of HES may do harm to renal function and therefore should be carefully considered in treatment of patients with severe renal dysfunction.

Ectopia renal cruzada com fusão: relato de dois casos e revisão da literatura / Crossed renal ectopia with fusion: report of two cases and review of the literature

Ectopia renal é uma das mais comuns anormalidades de desenvolvimento renal. Contudo, somente poucos casos de ectopia renal cruzada com fusão têm sido relatados na literatura. Ectopia renal cruzada, geralmente, é uma entidade clinicamente silenciosa, mas algumas vezes complica com infecção urinária de repetição e nefrolitíase e pode ser associada com uma alta incidência de obstrução da junção ureteropélvica, refluxo vesicoureteral e displasia renal multicística. Os autores relatam dois novos casos de ectopia renal cruzada com fusão diagnosticados em um contexto de infecção urinária e nefrolitíase e fazem uma revisão dos mecanismos e características clínicas desta anormalidade. O nefrologista deve estar familiarizado com esta alteração do desenvolvimento renal, uma vez que muitas complicações podem ocorrer durante o seguimento destes pacientes.

Renal ectopia is one of the most common renal abnormalities of kidney development. However, only a few cases of crossed fused renal ectopia have been reported in the literature. Although crossed renal ectopia is usually clinically silent, they is sometime responsible for infection and urinary stones and may be associated with a high incidence of ureteropelvic junction obstruction, vesicoureteral reflux and renal multicystic dysplasia. We report two new cases of crossed renal ectopia with fusion diagnosed in a context of kidney stones and urinary tract infection and review the mechanism and clinical features of this abnormality. We believe that Nephrologist must be familiar with this abnormality of kidney development, as a number of complications may appear during follow-up.

Study on renal perfusion of patients with liver cirrhosis by contrast-enhanced ultrasound / 中华超声影像学杂志

Objective To assess the renal perfusion of different severity of hepatic cirrhosis by contrast-enhanced ultrasound with time-intensity curve.Methods Forty hepatic cirrhosis patients with normal conventional renal function enrolled the study and were subdivided into Child-Pugh A group ( n =14),Child-Pugh B group ( n =14) and Child-Pugh C group ( n =12).Thirty healthy subjects were selected as the control group.The parameters of perfusion were compared among the groups.The correlations between parameters and score of Child-Pugh were analyzed using Pearson correlation.Results The cirrhosis groups showed a decrease of peak intensity,increase of time to peak,and reduce of area under the curve in the renal cortex( P ＜0.05).Compared with Child-Pugh A group,the peak intensity decreased in both ChildPugh B and C groups,time to peak increased in Child-Pugh C group( P ＜0.05 or P ＜0.01 ).The peak intensity had negative correlation with Child-Pugh score( r =- 0.506,P ＜0.01 ).Conclusions Contrastenhanced ultrasound combined with time-intensity curve can assess renal perfusion of hepatic cirrhosis quantitatively.The peak intensity was correlated to the severity of cirrhosis.

Effect of a Diet with Unrestricted Sodium on Ascites in Patients with Hepatic Cirrhosis

BACKGROUND/AIMS: There has been debate on whether a sodium-restricted diet (SRD) should be used in cirrhotic patients with ascites in China in recent years. The purpose of this study was to compare the effect of sodium-restricted and unrestricted diets on plasma renin activity (PRA), renal blood flow (RBF) and ascites in patients with liver cirrhosis. METHODS: Two hundred cirrhotic patients with ascites were randomly divided into two groups (98 cases in the sodium-unrestricted diet [SUD] group and 102 cases in the SRD group); 95 patients (96.94%) in the SUD group and 97 patients (95.1%) in the SRD group had post-hepatitis B cirrhosis. RESULTS: Blood sodium and RBF were higher in SUD group than in SRD group (p<0.001), while PRA were significantly lower in SUD group than the SRD group 10 days after treatment (p<0.001). Renal impairment caused by low blood sodium was higher in SRD group than in SUD group (p<0.01). Ascites disappeared in higher proportion of patients in SUD group than in SRD group (p<0.001). CONCLUSIONS: SUD can increase the level of blood sodium and RBF, and be beneficial to diuresis and ascite reduction and disappearance.

Changes in renal blood flow in elderly versus young and middle age patients during laparoscopic cholecystectomy / 中华麻醉学杂志

ObjectiveTo compare the changes in renal blood flow in elderly and adult patients during laparoscopic cholecystectomy.MethodsSixty ASA Ⅰ or Ⅱ patients of both sexes,aged 18-75 yr,weighing 48-78 kg,undergoing elective laparoscopic cholecystectomy were enrolled in this study.The patients were divided into 2 groups according to the age ( n =30): group Ⅰ young and middle-age (18-60 yr) and group Ⅱ elderly (61-75 yr).Anesthesia was induced with midazolam,fentanyl,propofol and vecuromium and maintained with infusion of propofol and remifentanil,isoflurane inhalation and intermittent iv boluses of vecuromium.The patients were intubated and mechanically ventilated.PETCO2 was maintained at 30-40 mm Hg.The probe of transesophageal echocardiography (TEE) was inserted into esophagus after tracheal intubation.The internal diameter and time integral of left renal artery were measured by TEE before pneumoperitoneum (baseline) and at 1,5,10,15,20 and 30 min of pneumoperitoneum and 1,5 min after deflation.The blood flow of left renal artery (LRAF) was calculated.The maximal derease in LRAF during pneumoperitoneum was analyzed.ResultsThe internal diameter and time integral of left renal artery and LRAF were significantly decreased during peumoperitoneum and at 1 min after deflation in both groups ( P ＜ 0.05).LRAF before peumoperitoneum was significantly lower,and the time point of LRAF maximum decrease during pneumoperitoneum was later in group Ⅱ than in group Ⅰ ( P ＜ 0.05).ConclusionThe renal blood flow is temporary decreased during laparoscopic cholecystectomy both in young and middle age and elderly patients.The time point of LRAF maximum decrease in elderly patients is later than that in adult patients.

Effects of therapy with small volume of different fluids on renal blood flow in endotoxemia rats / 中华麻醉学杂志

Objective To evaluate the effects of therapy with small volume of different fluids on renal blood flow in endotoxemia rats.Methods Thirty parthogen-free SD rats weighing 180-250 g were randomly divided into 5 groups (n = 6 each):group Ⅰ control; group Ⅱ LPS; group Ⅲ LPS + 7.5 % hypertonic saline (HS);group Ⅳ LPS + hydrozyethly starch (HES) 130/0.4 and groupⅤ LPS + hypertonic saline plus hydroxyethly starch (HS-HES) 40. The animals were anesthetized with intraperitoneal 3% pentobarbital 40 mg/kg. Left carotid artery was cannulated for BP and HR monitoring and fluid administration. In groupⅡ-Ⅴ LPS 1 mg/kg was administered via arterial cannula. In group Ⅲ, Ⅳ and V 4 ml/kg of 7.5% HS, HES 130/0.4 AND HS-HES 40 were administered via arterial cannula respectively at 30 min after LPS administration.In groupⅠ and Ⅱ normal saline 4 ml/kg was given insteadt. Renal blood flow was measured with Doppler ultrasound before LPS (T1 ,baseline), at 30 min after LPS (T2), 10, 30 and 60 min after fluid therapy (T3, T4, T5). The animals were then sacrificed and both kidneys were removed for microscopic examination with light microscope. Results Renal blood flow was significantly decreased and was significantly recovered to some extent by therapy with different fluids especially with HS-HES 40 in group Ⅴ. Conclusion Therapy with small volume of HS,HES or HS-HES could increase renal blood flow and inprove renal microcirculation especially HS-HES.

Role of nitric oxide and prostaglandin in the maintenance of cortical and renal medullary blood flow

This study was undertaken in anesthetized dogs to evaluate the relative participation of prostaglandins (PGs) and nitric oxide (NO) in the maintenance of total renal blood flow (TRBF), and renal medullary blood flow (RMBF). It was hypothesized that the inhibition of NO should impair cortical and medullary circulation because of the synthesis of this compound in the endothelial cells of these two territories. In contrast, under normal conditions of perfusion pressure PG synthesis is confined to the renal medulla. Hence PG inhibition should predominantly impair the medullary circulation. The initial administration of 25 µM kg-1 min-1 NG-nitro-L-arginine methyl ester produced a significant 26 percent decrease in TRBF and a concomitant 34 percent fall in RMBF, while the subsequent inhibition of PGs with 5 mg/kg meclofenamate further reduced TRBF by 33 percent and RMBF by 89 percent. In contrast, the initial administration of meclofenamate failed to change TRBF, while decreasing RMBF by 49 percent. The subsequent blockade of NO decreased TRBF by 35 percent without further altering RMBF. These results indicate that initial PG synthesis inhibition predominantly alters the medullary circulation, whereas NO inhibition decreases both cortical and medullary flow. This latter change induced by NO renders cortical and RMBF susceptible to a further decrease by PG inhibition. However, the decrease in medullary circulation produced by NO inhibition is not further enhanced by subsequent PG inhibition.

Effects of Magnesium Sulfate on Supraceliac Aortic Unclamping in Experimental Dogs

Intravascular administration of magnesium (Mg) causes vasodilation and increases renal blood flow. The aim of this study was to investigate the renal effect of Mg following unclamping of the supraceliac aorta. Mongrels were divided into two groups, control (group C, n=7) and Mg group (group Mg, n=7). In group Mg, 30 mg/kg MgSO4 was injected as a bolus immediately prior to unclamping the supraceliac aorta and thereafter as an infusion (10 mg/kg/hr). The group C received an equivalent volume of saline solution. Systemic hemodynamics, renal artery blood flow, renal cortical blood flow (RCBF), renal vascular resistance, and renal function were compared. Following the aortic unclamping, cardiac output and RCBF were less attenuated, and the systemic and renal vascular resistance was elevated to a lesser degree in the group Mg compared to the group C. There was no significant difference in the plasma renin activity, serum creatinine and Cystatin-C between the two groups. The present study shows that Mg infusion improves systemic hemodynamics and RCBF after aortic unclamping. However, we did not observe any improvement in renal function when Mg was administered after supraceliac aortic unclamping.

Different types of Budd Chiari syndrome showed different circulation directions / 介入放射学杂志

Objective To improve the knowledge for flow direction of renal spleen circulation in Budd Chiari syndrome and effects in treatment. Methods Two Budd Chiari syndrome patients with reno splenic venous shunt were treated by PTA, and the circulation directions were investigated. Results One case with hepatic vein occlusion showed the circulation from left renal spleen vein to IVC; another case with IVC stenosis proximal to heart showed the flow direction from spleen left renal vein to varices and finally to SVC. The circulation disappeared after treatment with PTA.Conclusions The direction of circulation in different types of Budd Chiari with portal hypertension may be different and should be identified clearly for a suitable management.