Renal hemodynamic changes assessed by Color Doppler ultrasound in children with liver cirrhosis

Abstract EN

Background : 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.

These early hemodynamic changes are secondary to renal vasoconstriction, splanchnic vasodilatation and receptor activation.

Aims: to detect early hemodynamic changes in children with liver cirrhosis who had clinically and laboratory normal kidney function, to measure the pulsatility (PI) and resistance (Rl) indices in children with different stages of liver cirrhosis (Child's grading of liver cirrhosis), to compare them with that of apparently healthy age and sex matched children as a control group and their correlation to some risk factors (severity of cirrhosis, renal infection, blood hemoglobin level and the presence of portal hypertension).

Methods : Thirty children with liver cirrhosis of different stages (10 children with Child's class A, 10 children with Child's class B and 10 children with Child's class C) using Child- Turcotte- Paugh Score, all of them with normal kidney function tests as well as 10 apparently healthy children as a control group were included.

The following investigations were done to all cirrhotic children, complete blood picture, liver and kidney function tests, prothrombin time and concentration, total plasma protein and serum albumin, urine analysis, (urine culture if needed) and abdominal ultrasound.

PR and PI were measured by Doppler spectral wave analysis for patients and control.

Results : Both PI index and Rl index are significantly higher in all children with liver cirrhosis compared with the contiol group.

Both indices showed highest values with class C compared with class B and A.

Each correlated significantly with anemia, renal infection and the presence of portal hypertension.

Conclusion: Monitoring of resistance indices (PI and Rl) measured noninvasevely by Doppler ultrasound is an effective and easy method for detection of very early renal hemodynamic alternation in childhood cirrhosis and consequently early proper management.

PI and Rl measured by noninvasive Doppler ultrasound were closely related to the severity of cirrhosis, renal infection and blood hemoglobin level as well as the presence of portal hypertension.