INTRODUCTION :
Several studies of Chronic liver disease have shown that arterial resistance is increased in cirrhotic patients with ascites. It is related to the severity of cirrhosis and to the renal blood flow, aids in predicting progression into hepatorenal syndrome, and is available as a prognostic factor.
The Pulsatility index and resistive index are estimated from blood flow velocity waveform analysis by Doppler studies .They are widely accepted and used as valid indicators of renal vascular resistance. The measurement of renal arterial resistance by Doppler has been found to be useful in the study of organic and/or functional renal diseases in cirrhosis. In fact, elegant studies by Kew and colleagues have demonstrated that with the 133Xe washout technique that the renal blood flow is reduced even in well-compensated cirrhosis. Epstein et al. have also shown in their studies with the 133Xe washout technique and renal angiography that mean renal blood flow and renal cortical perfusion are reduced in cirrhotic patients. At present the renal arterial resistance can be easily assessed by measuring the pulsatality index or resistive index with real-time color Doppler studies of renal arteries. Patients with advanced chronic liver diseases often exhibit an abnormal hemodynamics that is characterized by a hyperdynamic circulation in the splanchnic and systemic areas. Schrier [et al.] proposed that these homodynamic changes might be due to peripheral hemovasodilatation, which could be recognized even in the very early stage of liver cirrhosis. The resulting Peripheral vasodilatation and the resulting reduced systemic vascular resistance might contribute to the reduced effective blood flow estimated from blood flow velocity waveform analysis.
AIM OF THE STUDY :
1. To calculate the renal arterial Resistive index, Pulsatility index in patients with chronic liver disease.
2. To calculate renal arterial RI index in patients with chronic liver disease and its correlation with severity of chronic Liver disease.
3. To study the usefulness of RI as a noninvasive predictor of response to diuretic therapy in chronic liver disease.
4. To study renal arterial resistive index and its association with esophageal varices in patients with chronic liver disease.
CONCLUSION :
1. Renal Resistive index and pulsatality index are abnormal in most of the patients with cirrhosis.
2. Renal Resistive index and the pulsalility index are increased even in patients with normal renal function tests.
3. Renal Resistive index and pulsatality index show a significant and a positive correlation with increasing grade of cirrhosis.
4. Renal Resistive index is a invasive predictor of response to diuretic treatment of ascites in cirrhosis.
5. A high level of RI correlates with presence of esophageal varices
