PURPOSE: To evaluate the frequency of increased renovascular impedance and
its relationship with the presence of esophageal varices in patients with C
hild-Pugh class A cirrhosis without ascites.
MATERIALS AND METHODS: The intraparenchymal renal resistive index (RI) (ref
erence value, <0.7) and portal congestive index (ie, the ratio between the
portal cross-sectional area and mean flow velocity; reference value, <0.07)
were measured by using duplex Doppler ultrasonography in 50 consecutive pa
tients. The frequency of varices was assessed endoscopically. The data were
analyzed with the Fisher exact test.
RESULTS: The renal RI was consistent with increased impedance (ie, >0.7) in
18 (36%) patients and was normal in 32 (64%). The proportion of patients w
ith varices was significantly higher in the former group: 14 (78%) versus 1
0 (31%) (P =.002). In detection of the presence of varices, the renal RI wa
s uniformly better than the portal congestive index in terms of sensitivity
(58% vs 48%), specificity (84% vs 54%), and positive (3.60 vs 1.04) and ne
gative (0.50 vs 0.96) likelihood ratios. RI determination improved the abil
ity to exclude the presence of varices from a basal pretest probability of
52% (26 of 50 patients) to a final one of 69%, (22 of 32 patients) and that
of predicting the presence of varices from 48% (24 of 50 patients) to 78%
(14 of 18 patients).
CONCLUSION: A substantial proportion of patients with Child-Pugh class A ci
rrhosis without ascites have increased renovascular impedance; this signifi
cantly correlates with the presence of varices.