Renal Hemodynamic Changes Assessed by Color Doppler Sonography in Children With Liver Cirrhosis

Abstract

Detection of early renal affection before proceeding to hepatorenal failure as a complication of liver cirrhosis in children will be helpful in the prognosis of the disease. The objective of this study was to detect early hemodynamic changes in children with liver cirrhosis who had normal kidney function tests to measure the pulsatility index (PI) and resistance index (RI) and their correlation to some risk factors (severity of cirrhosis, renal infection, blood hemoglobin level, and the presence of portal hypertension). Thirty children with different stages of liver cirrhosis (with normal kidney function tests) and 10 apparently healthy children were included. RI and PI were measured by Doppler spectral wave analysis for patients and control. Both PI and RI indices were significantly higher in all children with liver cirrhosis compared with the control group. Both indices showed highest values with class C compared with classes B and A. Each was significantly higher in the presence of anemia, renal infection and portal hypertension. Monitoring of resistance indices (PI and RI) measured noninvasively by Doppler sonography is an effective and easy method for detection of very early renal hemodynamic alternation in childhood cirrhosis and consequently early proper management.

Keywords

childhood cirrhosis renal hemodynamics duplex Doppler sonography

References

Wadei HA , Mai ML , Ahsan N. , Gonwa TA : Hepatorenal syndrome: pathophysiology and management. Clin J Ann Soc Nephrol 2006;1:1066-1079.

Platt JF , Ellis JH , Rubin JM , Merion RM , Lucy MR : Renal duplex Doppler ultrasonography: a noninvasive predictor of kidney dysfunction and hepatorenal failure in liver disease. Hepatology 1994;20:362-369.

Abdallah AF , Bakr AM , El-Haggar M. , Amer T. : Renal hemodynamic changes in children with liver cirrhosis. Pediatr Nephrol 1999;13:854-858.

Kastelan S. , Ljubicic N. , Katelan Z. , Ostojic R. , Uravic M. : The role of duplex-Doppler ultrasonography in the diagnosis of renal dysfunction and hepatorenal syndrome in patients with liver cirrhosis. Hepatogastroenterology 2004;51:1408-1412.

Arroy V. , Guevara M. , Gines P. : Hepatorenal syndrome in cirrhosis: pathogenesis and treatment. Gastroenterology 2000;122:1658-1676.

Gines P. , Guevara M. , Arroyo V. , Rodes J. : Hepatorenal syndrome. Lancet 2003 ;362:1819-1827.

Kelley WN , Dupont HR , Holmens ED , et al: Child-Turcotte-Pugh score, in Dupont HD , Holmes EW , Glick HJ , Hudson LD (eds): Textbook of Internal Medicine. 3rd ed. Philadelphia, Lippincott-Raven , 1997.

Celebi H. , Dödner, Celiker H : Renal blood flow detection with Doppler ultrasonography in patients with hepatic cirrhosis. Arch Intern Med 1997 ;157:564-566.

Unceta RP , Rodriguez MMA , Guilen MP , Carera TM , Sierra MC , Herrera ML : Renal Doppler ultrasonography and its relationship with the renal function in patients with liver cirrhosis. Medicina Clinica 2001;116:561-564.

10.

Sacerdoti D. , Merlo A. , Merkel C. , Zuin R. , Gatta A. : Redistribution of renal blood flow in patients blood flow in patients with liver cirrhosis: the role of renal PGE2. J Hepatol 1986;2:253-261.

11.

Maroto A. , Gines A. , Salo J. , et al: Diagnosis of functional kidney failure of cirrhosis with Doppler sonography: prognostic value of resistive index. Hepatology 1994;20:839-844.

12.

Berzigotti A. , Casadei A. , Magalotti D. , et al: Renovascular impendence correlates with portal pressure in patients with liver cirrhosis . Radiology 2006;240:581-586.

13.

Wyllie R. : The liver and the biliary system, in Kligman RM , Behrman RE , Jenson HB , Staton BF (eds): Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Saunders, 2007, pp 1657-1713.

14.

Gines P. , Arroyo V. : Hepatorenal syndrome. J Am Soc Nephrol 1999 ;10:1889-1839.

15.

Navasa M. , Follo A. , Fiella X. , et al: Tumor necrosis factor and interleukin-6 in spontaneous bacterial peritonitis in cirrhosis: relationship with the development of renal impairment and mortality. Hepatology 1998;27:1227-1232.

16.

Follo A. , Llovet JM , Navasa M. , et al: Renal impairment after spontaneous bacterial peritonitis in cirrhosis: incidence, clinical course, predictive factors and prognosis. Hepatology 1994;20:1495-1501.

17.

Ruiz-del-Arbol L. , Urman J. , Fernndez J. , et al: Systemic, renal and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis. Hepatology 2003;38:1210-1218.

18.

Cardenas A. , Gines P. : Pathogenesis and treatment of fluid and electrolyte imbalance in cirrhosis . Semin Nephrol 2001;21: 308-316.

19.

Sort P. , Navasa M. , Arroy V. , et al: Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med 1999;341:403-409.

20.

Gines A. , Fernandes-Esparrach G. , Monescillo A. , et al: Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis. Gastroenterology 1996;111:1002-1010.

21.

Garcia-Compean D. , Blanc P. , Larrey D. , et al: Treatment of cirrhotic tense ascites with dextran-40 versus albumin associated with large volume paracentesis: a randomized controlled trail. Ann Hepatol 2002;1:29-35.

22.

Duvoux C. , Zanditenas D. , Hezode C. , et al: Effect of noradrenalin and albumin in patients with type 1 hepatorenal syndrome: a pilot study. Hepatology 2002;36:374-380.