The Value of Intrarenal Resistive Index in Patients with Liver Cirrhosis

ABSTRACT

PURPOSE: To determine whether the value of the intrarenal resistive index (RI) can be used to identify early kidney vasoconstriciton in patients with nonazotemic liver cirrhosis MATERIALS AND METHODS: The intrarneal resistive index(RI), kidney and liver function and plasma renin activity were measured in 12 healthy control subjects, 13 cirrhotic patients without ascites and 29 cirrhotic patients with ascites. To evaluate the development of hepatorenal syndrome, patients were followed up for six months. RESULTS: RI was significantly higher in patients with cirrhosis (0.68+/-0.06) than in healthy subjects(0.59+/-0.04). In 42 cirrhotic patients, it was significantly higher in those with ascites (0.69+/-0.05) than in those without ascites(0.64+/-0.05) and correlated with creatinine clearance. Plasma renin activity was significantly highter in cirrhotic patients with ascites than in those without ascites and healthy subjects(p<0.05). During the six-month follow-up period, kidney dysfunction developed in 16% (7/42) of cirrhotic patiens, and in 37% (6/16) of those with an elevated RI. In contrast, only 4% (1/26) of patients with a normal RI has kidney dysfunction. CONCLUSION: The measurement of intrarenal resitive index (RI) using duplex Doppler ultrasound is a simple, noninvasive method of detecting even subtle derangements of renal hemodynamics in liver cirrhosis patients; the procedure can be used to identify those who are at higher risk of overt renal failure and to help decide whether a therapeutic approach involving paracentesis, diuretics, or nephrotoxic agents is most appropriate.