الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
_________________________ SIIIIIIII”ry All/I Cl/lldll,fllIII
SUMMARY AND CONCLUSION
Cirrhotic patients exhibit a wide spectrum of progressive and
interrelated splanchnic, systemic and renal haemodynamic changes
causing disturbed renal function which is attributed to reduced renal
blood flow due to severe intrarenal arterial vasoconstriction, increased
renovascular resistance and subsequent decreased renal perfusion in
response to imbalance between vasoconstrictor and vasodilator forces
acting on the inrarenal arteries,
The present study was designed to determine the renal, splanchnic
and systemic hacmodynumic changes that occur in chronic liver disease
at different stages and to correlate these changes with the clinical and
laboratory changes, Also, to study the effect of some therapies on the
I-IRS group.
In this study, the heart rate was increased in ascitic than cirrhotic
without ascites and chronic hepatitis group, with more increase in the
HRS group. The MAP was decreased with the progression of the disease,
being lower in HRS more than ascitic, cirrhotic without ascites and
chronic hepatitis groups.
(IRS, is a well recognized complication of liver cirrhosis and
shows early renal haemodynamic changes before maintenance of
manifest renal dysfunction. This is due to decreased renal perfusion due
to imbalance between vasoconstrictor and vasodilatory forces acting on
kidneys. Decrease in renal plasma flow is associated with peripheral
arterial vasodilatation. Increased renal arterial vascular resistance causes
renal insufficiency that can be detected non-invasively by Doppler ultras-
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-onography.
i
In this study, the intrarenal impedance lindices (RI and PI) were
found elevated in cirrhotic patients than in pat~nts with chronic hepatitis
und development of ascites is associated 1ith further increase. The
highest values were present in the HRS group.jl’hese results confirm that,
in liver cirrhosis, the intrarenal arterial vas040nstriction, the increased
I
renal ~ascl~lar resistance, the decreased renal perfusion .with su~sequent
renal impairment occur proceed the developme,nt of ascites and Increase
in severity with evolution of ascites. :
I
The present study detected renal i impairment and renal
vasoconstriction in 53.3% of patients with nor~, al renal function, namely
serum creatinine. After 2 months follow up of these patients 3 out of 8
,
(38%) had HRS major criteria. i
I
WI: aSSUIll<: that, Rl of 0.7 might represent the cutoff critical level
impending high risk of developing overt renaf failure. The sencitivity of
this measurement was found to be as 100% and the specificity 58.3%.
The very high sencitivity of this technique in prediction of HRS is very
reliable in the clinical context. The low specificity (58.3 % in this study)
is not a major setblock as the test is meant to be a ”screening procedure”.
Cirrhotic parients with normal creatinine leve’ls but with increased renal
RI at higher risk of kidney failure than those with normal RI. So patients
having RI of ~ 0.7 should be dealt with cautiously with exclusion of any
factors which would increase renal hypoperfusion. Follow up of these
patients and choosing the suitable therapeutic approaches are mandatory.
The intrarenal RI was also best correlated with severity of
hepatocellular dysfunction and for studying early renal haemodynamic
alterations and shows progressively increased levels with the evolution of
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the disease with the deterioration of renal function and with the activation
of endogenous vasoactive systems.
The present study dcmonstrutcs (hut the most important predictors
of HRS : are the intrarenal RI; the femoral blood flow volume; the sp~enic
artery PI and the sreum albumin.
The study concluded that, vasodilation in patients with liver
cirrhosis occurs mainly in splanchnic arterial circulation and play an
important role in the pathogenesis of decreased systemic vascular
resistance seen in patients with cirrhosis.
Also, the study showed that, the femoral blood llow was increased
in ascitic patients indicating participation of extrasplanchnic system in the
systemic vasodilaton.
The present study showed that, there was no statistical signi ficant
changes in intrarenal impedance indices between subgroup was given
plasma from subgroup was given albumin. Both plasma and albumin are
increasing the serum albumin nearly the same.
\,
When octreotide and midodrine were added to albumin, there was
highly significant increase of MAP, more decrease of heart rate with high
increase of urinary sodium and urine volume.
The most strikingly was improvement of renal haemodynumic
changes represented by highly significant changes in intrarenal RI and PI.
The serum creatinine became significantly improved.
The conclusion that can be reached on the basis of this study may
be important for future research. Is that administration of vasoconstrictors
with albumin is a good and effective treatment of HRS. However, more
studies are needed to determine the best vasoconstrictor and the optimal
dose.