Japanese Journal of Portal Hypertension

The diagnosis of esophageal varices is relevant to the determination of blood flow in the collateral vessels. Previously we have shown that the introduction of contrast enhancement to the routine ultrasonography (US), which improved the standard US system allowed evaluation of blood flow in the esophageal varices. We compared our observations on esophageal varix between endoscopy and contrast enhanced US, and assessed the diagnostic power of contrast enhanced US in the management of esophageal varix. US was performed in 50 patients with hepatoceller carcinoma. Based on the examinations of the form and the red color sign in the contrast enhanced US, we were able to visualize the esophageal varices and select candidates for treatment at high rates. Approximately 90% of esophageal varix cases in which the lumen of the lower esophagus was strongly enhanced showed indications for treatment. This improved version of US was minimally invasive and enabled us to detect varices as candidates for treatment at a high rate. Contrast enhanced US was thought to be a useful modality to evaluate blood flow of esophageal varices.

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A total of 929 patients with liver cirrhosis were admitted to our department between 2004 and 2009. Of these, 142 patients were complicated by kidney injury, with creatinine of 1.5 mg/dl or higher at or after admission. One hundred six out of 142 patients developed acute kidney injury, and including 27 with type 1 hepatorenal syndrome.
We retrospectively investigated the background, treatment and prognosis of type 1 hepatorenal syndrome in 27 patients. The 27 patients were selected according to the diagnostic criteria for hepatorenal syndrome proposed by International Ascites Club. Average Child-Pugh score was 12.4, total bilirubin 15.1 mg/dl, and creatinine 3.22 mg/dl in the 27 patients. Precipitating factors were infection (n=16), paracentesis (n=5) and other causes (n=6). These 27 patients were treated with albumin (n=21), terlipressin (n=11), dopamine (n=11), noradrenaline (n=1), hemodiafiltration (n=1). Of 16 patients treated with conventional therapies other than terlipressin, 15 died. Their mean survival time was 12 days.
Type 1 hepatorenal syndrome occurred in 25% of the cirrhotic patients with acute kidney injury. This syndrome developed as a consequence of severe hepatic failure and the prognosis following conventional therapy was quite poor.

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