الفهرس 
ACKNOWLEDGEMENTSOnly 14 pages are availabe for public view
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Abstract
Hepatorenal syndrome (HRS) is defined as the occurrence of renal failure in a patient with advanced liver disease in the absence of an identifiable cause of renal failure.
Cyst C has been proposed as an alternative marker of renal function because of its possible advantages over serum creatinine. However, there are some limitations for Cyst C. In addition to its high cost, Cyst C is not standardized and may be elevated in other situations as infection, diabetes, thyroid disease, and in those treated with steroids.
Renal resistance index (RRI) is the most frequently used parameter to assess intra-renal resistance and is calculated based on intra-renal duplex Doppler ultrasound measurements.
This study was designed to evaluate the clinical usefulness of increased serum Cyst C and renal resistance index for predicting renal dysfunction and mortality in patients with cirrhotic ascites and a normal creatinine level.
The current study included 100 patient were previously diagnosed to have liver cirrhosis and ascites. Based on the serum creatinine level and renal artery resistance index (RRI), those patients were subdivided into three groups; group I (30 patients with HRS), group II (40 patients with normal serum creatinine and increased RRI) and group III (30 patients with normal serum creatinine and normal RRI).
The current study showed increased serum Cyst C in patients with HRS and those with increased RRI in comparison to those with normal RRI.
It was found a significant positive correlation between RRI and level of serum Cyst C. Also, Cyst C had significant positive correlation with creatinine clearance.
group II (40 patients with normal serum creatinine and increased RRI) were randomly classified into subgroups (IIA, IIB) where group IIA included 19 patients who received prophylactic therapy against HRS and group IIB included 21 patients and didn’t receive prophylactic therapy. Both subgroups were followed for six months by serum creatinine and RRI.
Progression to HRS was significantly higher in group IIB (76.2%) in comparison to group IIA (31.5%). It was found that low serum albumin, raised serum Cyst C and raised RRI were predictors to develop HRS in patients with advanced liver cirrhosis.
Death was frequent in those patients didn’t receive prophylactic therapy against HRS (67%) in comparison to those patients who were received prophylactic therapy (47%).
It was found that serum cystatin at cut off point > 0.78 mg/dl has sensitivity and specificity 86.4% and 100 respectively for prediction of HRS in patients with advanced liver cirrhosis.