الفهرس 
INTRODUCTION AND AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
Aim of the work
The aim of this work is to study the renal resistive index and pulsatility index measured by renal Doppler ultrasonography in various stages of liver cirrhosis and their values to detect cirrhotic patients at particular risk for development of hepatorenal syndrome.
Summary
This study has been carried out on 60 cirrhotic patients selected from those admitted to Tropical medicine department in Minia university Hospital they were 35 males and 25 females with age ranging from 30 to 65 years. The patients were classified into 4 equal groups each of them is 15 in number ; group A (compensated cirrhosis), group B (diuretic responsive ascites), group C (refractory ascites) and group D (hepatorenal syndrome). Ten healthy subjects as a control (group E). All patients had no clinical or laboratory evidence of diabetes mellitus, hypertension or renal disease.
Our aim was to study both the renal resistive index and pulsatility index of both interlobar and arcuate arteries in different stages of liver cirrhosis via renal duplex Doppler ultrasonography. Early identification of changes in the RI and in the PI in patients with established liver disease who are at particular risk for the development of the hepatorenal syndrome may be beneficial because clinical management maybe modified.
It was found that both RI and PI of interlobar and arcuate arteries correlate with the severity of liver disease that both RI and PI of interlobar and arcuate arteries in patients with refractory ascites are significantly higher than those with diuretic responsive ascites while in patients with diuretic responsive ascites are significantly higher than those with compensated liver cirrhosis while there is no significant changes in RI or PI between patients with refractory ascites and patients with hepatorenal syndrome. Also, it was found that urinary sodium concentration is correlated with the severity of liver disease and significantly decrease with the increase in the degree of hepatic decompensation that urinary sodium concentration in patients with refractory ascites is significantly lower than those with diuretic responsive ascites and in patients with diuretic responsive ascites is significantly lower than those with compensated liver cirrhosis and in patients with hepatorenal syndrome is significantly lower than those with refractory ascites. However it was found that Creatinine clearance is less accurate and less sensitive in detection of group at particular risk for development of hepatorenal syndrome and RI and PI are superior and more sensitive than Creatinine clearance in patients with liver cirrhosis for detection of group of patients at risk for development of HRS.
Conclusions:
• Both renal resistive index and pulsatility index increase as the degree of hepatic decompansation of patients with liver diseases increases.
• Increases in both renal resistive index and pulsatility index and decreases in the urinary sodium concentration demonstrate the functional renal haemodynamic changes in patients with advanced liver cirrhosis and can help to detect patients at higher risk for the development of the hepatorenal syndrome.
• Renal duplex Doppler investigation is a non invasive, simple and easy method to study intrarenal haemodynamics in patients with liver cirrhosis.