Renal Resistive Index as a Prognostic Indicator in Patients With Hepatic Cirrhosis: An Analytical Cross-Sectional Study

TL;DR

This study explores how the renal resistive index, measured via ultrasound, can predict kidney issues in people with liver cirrhosis.

Contribution

The study demonstrates that the renal resistive index could serve as a non-invasive predictor of hepatorenal syndrome in cirrhosis patients.

Findings

The mean renal resistive index was significantly higher in cirrhosis patients (0.77) compared to healthy individuals (0.61).

Intrarenal Doppler ultrasound may help detect and monitor kidney dysfunction in cirrhosis patients.

The study suggests RRI could be a useful non-invasive tool for early detection of hepatorenal syndrome.

Abstract

Introduction

Cirrhosis of the liver is a chronic condition marked by scarring and the formation of abnormal nodules, which progressively disrupt normal liver function. In some individuals with cirrhosis, kidney dysfunction may develop without an obvious cause, a condition known as hepatorenal syndrome (HRS). The renal resistive index (RRI), measured via Doppler ultrasound, is a parameter used to assess blood flow resistance in the kidneys. This study aimed to assess the association between the renal resistive index and cirrhosis of the liver and to determine whether intrarenal Doppler can help indicate the presence of hepatorenal syndrome in such cases.

Methodology

An analytical, comparative cross-sectional study was conducted during the study period of August to October 2024 at the Department of Medicine, RL Jalappa Hospital, involving 20 patients diagnosed with cirrhosis and 20 healthy controls. Individuals with conditions such as diabetic nephropathy, renal artery stenosis, urinary tract infections (UTIs), urinary abnormalities, hypotension, bradycardia, and haemoglobinopathies were excluded. All participants underwent clinical evaluation, renal function tests, and intrarenal Doppler ultrasonography. Appendix 1 shows case sheet proforma. Sociodemographic and clinical data were collected using a structured questionnaire. Doppler measurements of peak systolic and end-diastolic velocities were used to calculate the RRI. Scans were performed by a single radiologist after overnight fasting. Data analysis was carried out using IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.

Results

Approximately 18 (45%) of both cirrhosis cases and healthy individuals were aged over 60 years. The majority of participants were male. The mean serum bilirubin level was 3.17 mg/dL in cirrhosis cases and 1.1 mg/dL in healthy individuals. The mean international normalized ratio (INR) was 2.1 in cirrhosis cases and 1.3 in healthy individuals. Ascites was present in 11 (55%) and hepatic encephalopathy in 10 (50%) of the cirrhosis cases. The mean renal resistive index was 0.77 in cirrhosis patients and 0.61 in healthy individuals.

Conclusion

This study highlights the significant role of intrarenal RI measurement as a potential predictor in patients with liver cirrhosis. It may serve as a non-invasive tool for early detection and regular monitoring of patients at risk of developing renal impairment, including hepatorenal syndrome.

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