The Value Of Ultrasonography For The Diagnosis Of Subclinical Hepatorenal Syndrome

Hepatorenal syndrome is a reversible and functional renal failure which occurs in patients with major liver disease and portal hypertension. It is characterized by a marked decrease in glomerular filtration rate and renal plasma flow,and the circulatory dysfunction. There is not effective therapy for the HRS, the prognosis is very poor. The patients'glomerular filtration rate and renal plasma flow have decreased before the increase of the serum creatinine and usea nitrogen, which is called subclinical HRS, which is could not be diagnosed by the normal renal function detection. Because of the endotoxemia, undue diuresis and the hemorrhage of digestive tract, the subclinical HRS will become HRS. The renal dysfunction is functional and reversible, so the Doppler ultrasonography is helpful for the diagnosis of preclinical hepatorenal syndrome.This article is to evaluate the value of Doppler ultrasonography used in the diagnosis of preclinical hepatorenal syndrome. Doppler ultrasonography was applied to detect the inner diameter of renal artery and the renal hemodynamic parameters in the hepatic cirrhosis patients in the discompensatory stage or in the compensatory stage, whose renal function was normal, and the results were compared with those of the control group. There was no significant difference in the renal hemodynamic parameters between the control group and the hepatic cirrhosis patients in the compensatory stage. The renal aorta caliber of the renal aorta in the hepatic cirrhosis patients in the discompensatory stage was significantly lower than that in those in the compensatory stage and that in the control group (P<0.01). The peak systolic velocity (PSV) and the renal aorta caliber of the renal aorta , segmental artery and interlobar artery in the hepatic cirrhosis patients in the discompensatory stage was significantly lower than that in those in the compensatory stage and that in the control group (P < 0.01). Significant changes were found in the end diastolic velocity (EDV) of the renal aorta , segmental artery and interlobar artery between the hepatic cirrhosis patients in the discompensatory stage and the other two groups(P<0.01).But resistive index (RI) in hepatic cirrhosis patients in the discompensatory stage were markedly higher than that in hepatic cirrhosis patients in the compensatory stage and that in the control group (P<0.01).Doppler ultrasonography can objectively and sensitively evaluate the disturbance of renal hemodynamics of hepatic cirrhosis patients with normal renal function, and it is helpful in estimating the glomerular filtration rate and the status of renal hemodynamics, and it might be of great importance for the diagnosis of preclinical hepatorenal syndrome.