Unraveling the Hepatorenal Connection: Intrarenal Resistive Index as a Sentinel Diagnostic Tool in Chronic Liver Disease.

BACKGROUND: The early identification of renal dysfunction in cirrhotic individuals is pivotal, as renal vasoconstriction may manifest months before traditional biomarkers show significant alterations. Advanced diagnostic approaches are imperative for the detection of hepatorenal syndrome (HRS) during its early stages, enabling prompt clinical intervention and enhancing patient outcomes. METHODOLOGY: A prospective observational cross-sectional study was conducted in the Radiology Department at Shifa International Hospital. The study included patients aged 18-75 years who presented with documented ascites and were scheduled for abdominal ultrasound. A comparison was also performed with normal subjects. Exclusion criteria encompassed patients with ascites attributable to non-cirrhotic causes, a history of acute renal failure or renal impairment due to conditions such as diabetic nephropathy or glomerulonephritis. Data was collected using a structured proforma and subsequently analyzed using SPSS version 25. RESULTS: The mean portal vein diameter (± standard deviation) in millimeters was: in normal subjects, 7.6 ± 1.59; in cirrhosis without ascites, 9.8 ± 3.24; in cirrhosis with mild ascites, 10.3 ± 1.51; in cirrhosis with moderate ascites, 12.5 ± 1.55; and in cir rhosis with gross ascites, 16.3 ± 2.33. CONCLUSIONS: Early detection of renal impairment in cirrhotic patients can be effectively facilitated by measuring the Intrarenal Resistive Index (RRI) using renal duplex ultrasound. This non-invasive diagnostic method allows for the evaluation of intrarenal hemodynamics and has been shown to exhibit a positive correlation between RRI values and the degree of liver decompensation.