الفهرس Only 14 pages are availabe for public view
 |  | from | 239 |  |  |
| | | from | 239 | | |
Abstract
Renal dysfunction is common in patients with liver cirrhosis. Most abnormalities of kidney function in cirrhosis are of functional origin, they occur due to intrarenal vasoconstriction which is a consequence of complex changes of systemic hemodynamics complicating cirrhosis. Circulatory dysfunction in cirrhosis is characterized by arterial vasodilatation in the splanchnic circulation leading to increased activity of the endogenous vasoactive systems as a compensatory mechanism that result in vasoconstriction in other areas such as the brain, kidneys and liver.
Hepatorenal syndrome (HRS) is the end result of this circulatory dysfunction it has been considered to be the consequence of a progression of the splanchnic arterial vasodilation occurring in these patients. HRS is associated with a very poor outcome lacking effective therapeutic strategies.
Our aim of this study was to evaluate Plasma Renin Activity (PRA) & intrarenal resistive index (RI) for the detection of the early stages of renal dysfunction in chronic liver disease before HRS develops.
In this study, 60 patients at different stages of chronic liver disease were included, the patients were equally divided into 3 groups: group I included patients with compensated chronic liver disease & normal kidney function tests, Group II included patients with decompensated chronic liver disease & normal kidney function tests, Group III included patients with decompensated chronic liver disease & renal impairment.
All patients were subjected to detailed history taking & clinical examination, laboratory investigations including liver function tests, kidney function tests, complete blood picture, urine analysis, pelviabdominal ultrasonography, measuring of Plasma Renin Activity (PRA) by radioimmunoassay & measuring of intrarenal resistive index (RI) by Doppler ultrasonography.
Our results showed that RI levels in 14 of our 20 patients with liver cirrhosis and elevated creatinine were >0.70 with an average RI of 0.72. The correlation between increased RI and azotemia seems to confirm the role of vasoconstriction in the pathogenesis of cirrhotic kidney disease. However, intrarenal arterial RI values were already increased in the group of nonascitic cirrhotic patients with a mean of 0.62 ± 0.05 and even higher in ascitic patients with a mean of 0.67 ± 0.06.
Thus, RI measurement seems to identify renal vasoconstriction at an earlier time than elevated serum creatinine.
Also our results revealed a positive correlation between intrarenal (RI), the presence of ascites & hepatic encephalopathy. Our data proved a positive correlation between Resistive index(RI), bilirubin and INR, therefore this work confirmed a positive correlation between Child score and RI.
As regards PRA there was no statistical difference between the 3 groups. In our results there was no correlation between PRA, ascites & hepatic encephalopathy, there was no correlation with serum creatinine, bilirubin or INR. In our study there was no correlation between PRA & child score. Also PRA did not increase with the increase in RI that was noticed between the 3 groups.
Therefore evaluation of intrarenal RI is a reliable method for the assessment of early renal impairment in patients with liver cirrhosis due to increased vasoconstriction. While PRA failed to prove its reliability for this purpose