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Renal hemodynamic changes in children with liver cirrhosis
A F Abdallah1, A M Bakr, M El-Haggar
1Department of Pediatrics, Mansoura Faculty of Medicine, Mansoura, Egypt 35516.
Insights
Duplex Doppler ultrasonography reveals elevated renal vascular resistance indexes in children with cirrhosis, even before ascites develop. These indexes correlate with disease severity, offering a non-invasive method to monitor early renal changes.
Area of Science:
- Pediatric Nephrology
- Hepatology
- Diagnostic Imaging
Background:
- Childhood cirrhosis can lead to early renal function impairment.
- Assessing renal hemodynamics in pediatric liver disease is crucial for early intervention.
Purpose of the Study:
- To evaluate the sensitivity of duplex Doppler ultrasonography in detecting early renal function impairment in childhood cirrhosis.
- To assess intrarenal arterial pulsatility index (PI) and resistive index (RI) in relation to cirrhosis severity and renal function.
Main Methods:
- Duplex Doppler ultrasonography was used to measure intrarenal arterial PI and RI in ascitic and non-ascitic children with cirrhosis and healthy controls.
- Creatinine clearance and Child score were used to assess renal function and liver disease severity, respectively.
Main Results:
- Both PI and RI were significantly higher in ascitic and non-ascitic children with cirrhosis compared to controls.
- PI showed an inverse correlation with creatinine clearance and a positive correlation with Child score.
- No significant correlation was found between PI, RI, and portal hypertension.
Conclusions:
- Renal vascular resistance indexes are elevated in childhood cirrhosis, even in the non-ascitic phase.
- These indexes correlate with hepatocellular dysfunction severity (Child score) but not portal hypertension.
- Duplex Doppler ultrasonography provides a non-invasive method for monitoring early renal hemodynamic alterations in pediatric cirrhosis.
Abstract:
To assess the sensitivity of duplex Doppler ultrasonography in detecting early impairment of renal function in childhood cirrhosis, intrarenal arterial pulsatility index (PI) and resistive index (RI) were measured in 10 ascitic and 11 non-ascitic children with liver cirrhosis and normal creatinine clearance and 10 age- and sex-matched controls. PI and RI were higher in ascitic than non-ascitic children [PI 1.54+/-0.4 vs. 1.1+/-0.2 (mean +/- SD), P=0. 006; RI 0.76+/-0.07 vs. 0.68+/-0.07, P=0.03). Non-ascitic patients had higher PI and RI than controls (P=0.002 and 0.0001, respectively). PI was inversely correlated with creatinine clearance (r=-0.54, P=0.01). A significant positive relationship was observed between both PI and RI and Child score (r=0.47, P=0.009; r=0.45, P=0. 01, respectively). However, no significant correlation was observed between PI and RI and portal hypertension. We conclude that renal vascular resistance indexes evaluated by duplex Doppler ultrasonography are increased in the non-ascitic phase of cirrhosis. Development of ascites is associated with a further increase in these indexes. The resistance indexes are best correlated with severity of hepatocellular dysfunction, assessed by Child score, but not with portal hypertension. Hence, monitoring these indexes, especially PI, is a non-invasive means of studying early renal hemodynamic alteration in childhood cirrhosis.