RENAL DYSFUNCTION IN LIVER-CIRRHOSIS - RENAL DUPLEX-DOPPLER US VS. SCINTIGRAPHY FOR EARLY IDENTIFICATION

A diagnostic tool to detect early renal dysfunction before it becomes irreversible would be useful in cirrhosis, This study was carried out to evaluate the role of Doppler sonography and Tc-99m DTPA renography in the detection of early renal dysfunction in patients with different grades of liver cirrhosis. Renal arteries of 43 patients with cirrhos is and normal renal function tests were compared with 15 age and gende r matched normal subjects as a control group using colour Doppler sono graphy and Tc-99m DTPA scintigraphy, The patients were categorized int o three groups, A (14), B (14) and C (15), according to a modified Chi ld's classification that assesses the severity of liver cirrhosis, Dop pler results revealed a highly significant increase in both the pulsat ility and resistive indices in groups B and C compared with either gro up A patients or control subjects and in group C compared with group B (P < 0.001) in the main renal arteries as well as in the interlobar a nd arcuate arteries. Insignificant differences were observed between g roup A and controls (PI: control 0.96 +/- 0.08, group A 0.95 +/- 0.07, group B 1.26 +/- 0.06. group C 1.48 +/- 0.06; RI: control 0.57 +/- 0. 02, group A 0.58 +/- 0.02, group B 0.66 +/- 0.01, group C 0.72 +/- 0.0 2), Abnormal renograms in the form of delayed appearance (34 +/- 14.6 s), diminished blood how bilaterally with prolonged secretory (12 +/- 4.5 min) and excretory phases (> 30 min) and poor response to intraven ous frusemide were only observed in group C patients. within the norma l range in patients Radionuclide computed glomerular filtration rate w as wt of group A (81 +/- 9.5 ml/min) and group B (78 +/- 8.4 ml/min) a nd reduced only in patients of group C (34 +/- 14.5 ml/min), Thus Dopp ler sonography can detect an increase in renal vascular resistance in patients with moderately severe cirrhosis (Child grade B) when renogra phy was normal. We conclude that Doppler sonography can be used for ea rlier identification of cirrhotic patients with a higher risk of impen ding renal failure earlier than renography and may also be used to gui de therapeutic approaches.