Abstract
Hepatorenal syndrome (HRS) is a complication of cirrhosis of the liver, which may be mediated by changes in renal cortical blood supply. We investigated the relationship between hepatic and renal hemodynamics in patients with and without liver cirrhosis. Ten healthy subjects (N) and 22 patients with liver cirrhosis (LC) were evaluated. Ultrasound measurements of hepatic perfusion and renal blood flow were performed every 30 seconds for S minutes using the galactose-based intravenous contrast, Levovist (R) . Biochemical analysis of hepatic and renal function, systemic hemodynamic parameters, hANP levels, and neurohormonal parameters, were obtained simultaneously. Patients with liver cirrhosis were classified into three groups (A, B, or C) according to Child-Pugh's criteria. The hematocrit, which was significantly lower in grade C patients. Plasma rennin activity (PRA), norepinephrine (NE) and glucagon were significantly higher in LC patients than controls. The average time for hepatic parenchymal enhancement was significantly longer in grade C patients, compared with normal controls. The average time for renal parenchymal enhancement was also significantly longer in grade B and C patients, compared with normal controls. In grade C cirrhosis, not only was the enhancement time prolonged, but also the degree of hepatic and renal enhancement was less than in normal controls. Patients with liver cirrhosis have disordered renal blood flow at an early stage, despite maintaining a normal creatinine clearance. Contrast ultrasound can identify a subgroup of patients with liver cirrhosis who are at significantly higher risk of developing subsequent renal dysfunction and hepatorenal syndrome.
