Renal Doppler Indices in Chronic Liver Disease and its Role in Predicting Hepatorenal Syndrome

ABSTRACT

Introduction: Hepatorenal syndrome (HRS) is the most serious complication of renal dysfunction in patients with chronic liverdisease (CLD). Renal arterial vasoconstriction may persist for weeks, even months before an increase of blood urea nitrogenor serum creatinine values can be discovered.[1] Duplex Doppler ultrasonography of the kidneys is an easy and non-invasivemethod to assess blood flow and arterial vascular resistance as a parameter for vasoconstriction.[2-4] Intrarenal resistive index(RI) may be superior to serum creatinine levels as an indicator in patients with liver cirrhosis for the detection of patients at riskfor the development of HRS.Objective: The objective of the study was to correlate renal Doppler indices with serum creatinine levels in various stages ofCLD and to determine its role in predicting the risk for developing HRS in patients of CLD.Materials and Methods: Grayscale, color flow, and duplex Doppler ultrasonography were performed inpatients of CLD, whichwere divided into four groups with increasing clinical severities. There serum creatinine level was compared with renal Dopplerindices in various groups of increasing severity.Results: Most common cause of CLD in our study population was alcoholism (62%). About 65% of cases show irregular liversurface, and irregular liver surface is significantly higher in Groups II, III, and IV versus Group 1. Heterogeneous, homogenous,and fatty echo texture were showed by 78%, 11%, and 11%, respectively. Mean peak systolic velocity and end-diastolic velocityin our study are 33.99 cm/s and 11.55 cm/s, respectively. Mean pulsatility index in cases was 1.17. In our present study, RIlevel was significantly higher in cirrhotic patients, and there is a significant association between RI and study groups. As theseverity of liver disease of group increases, the RI value also gets elevated.Conclusion: Intrarenal RI seems to be a helpful predictor to identify a subgroup of CLD patients with a higher risk of developingkidney failure or HRS, which can translate into the early initiation of treatment for impending HRS.