Association of chronic liver disease with resistive index of intra-renal artery

Abstract

Background: Cirrhosis of the liver is characterized by a profound disarrangement of the parenchyma and intrahepatic circulation, which leads to portal hypertension. Several vascular changes occur in the course of hepatic cirrhosis leading eventually to renal vascular changes with consequent renal function affection. Renal hemodynamic changes with intense intrarenal vasoconstriction begin early in the course of liver disease before changes in the level of serum urea and serum creatinine. Resistive Index (RI) is the most widely used index for estimation of intrarenal vascular resistance and simple, effective, and non-invasive method that enables the early detection of renal hemodynamic disturbances in patients with liver cirrhosis even before renal dysfunction becomes clinically evident. Materials and methodology: Seventy subjects, 50 with Chronic Liver Disease (CLD) and 20 healthy control were examined and RI was calculated with color and spectral doppler sonography analysis. The mean RI among healthy controls was compared with patients with CLD. Further comparison of RI was made among CLD patients with different grades according to Child Turcotte Pugh’s classification and asities. Result: The mean RI value in patients with CLD was significantly higher than in healthy controls (0.71 ± 0.05 vs 0.55 ± 0.28). The RI values of patients with no ascites, Grade I, Grade II, and Grade III ascites were 0.65 ± 0.08, 0.68 ± 0.26, 0.75 ± 0.28, and 0.79 ± 0.09 respectively. (p< 0.01). Similarly, the RI value of patients with CLD also increased with an increase in the grading of CLD according to the Child Turcotte-Pugh classification (0.67 ± 0.05, 0.74 ± 0.30, 0.79 ± 0.50 for Child Turcotte-Pugh A, B and C groups respectively < 0.01). Conclusion: Renal duplex Doppler ultrasound is useful as a non-invasive method for the evaluation of renal hemodynamic changes in cirrhotic patients with a good correlation to the severity of the liver disease.