BACKGROUND: Renal hemodynamic measurements are complicated to perform in patients with cirrhosis, yet they provide the best measure of risk to predict hepatorenal syndrome (HRS). Currently, there are no established biomarkers of altered renal hemodynamics in cirrhosis validated by measured renal hemodynamics. METHODS: In this pilot study, simultaneous measurements of glomerular filtration rate (GFR), renal plasma flow (RPF), renal resistive indices and biomarkers were performed to evaluate renal hemodynamic alterations in 10 patients with cirrhosis (3 patients without ascites, 5 with diuretic-sensitive and 2 diuretic-refractory ascites). RESULTS: Patients with diuretic-refractory ascites had the lowest mean GFR (36.5 ml/min/1.73 m(2)) and RPF (133.6 ml/min/1.73 m(2)) when compared to those without ascites (GFR 82.9 ml/min/1.73 m(2), RPF 229.9 ml/min/1.73 m(2)) and with diuretic-sensitive ascites (GFR 82.3 ml/min/1.73 m(2), RPF 344.1 ml/min/1.73 m(2)). A higher mean filtration fraction (FF) (GFR/RPF 0.36) was noted among those without ascites compared to those with ascites. Higher FF in patients without ascites is most likely secondary to the vasoconstriction in the efferent glomerular arterioles (normal FF ~0.20). In general, renal resistive indices were inversely related to FF. While patients with ascites had lower FF and higher right kidney main and arcuate artery resistive indices, those without ascites had higher FF and lower right kidney main and arcuate artery resistive indices. While cystatin C and β2-microglobulin performed better compared to Cr in estimating RPF, β-trace protein, β2-microglobulin, and SDMA, and (SDMA+ADMA) performed better in estimating right kidney arcuate artery resistive index. CONCLUSION: The results of this pilot study showed that identification of non-invasive biomarkers of reduced RPF and increased renal resistive indices can identify cirrhotics at risk for HRS at a stage more amenable to therapeutic intervention and reduce mortality from kidney failure in cirrhosis.
BACKGROUND: Renal hemodynamic measurements are complicated to perform in patients with cirrhosis, yet they provide the best measure of risk to predict hepatorenal syndrome (HRS). Currently, there are no established biomarkers of altered renal hemodynamics in cirrhosis validated by measured renal hemodynamics. METHODS: In this pilot study, simultaneous measurements of glomerular filtration rate (GFR), renal plasma flow (RPF), renal resistive indices and biomarkers were performed to evaluate renal hemodynamic alterations in 10 patients with cirrhosis (3 patients without ascites, 5 with diuretic-sensitive and 2 diuretic-refractory ascites). RESULTS:Patients with diuretic-refractory ascites had the lowest mean GFR (36.5 ml/min/1.73 m(2)) and RPF (133.6 ml/min/1.73 m(2)) when compared to those without ascites (GFR 82.9 ml/min/1.73 m(2), RPF 229.9 ml/min/1.73 m(2)) and with diuretic-sensitive ascites (GFR 82.3 ml/min/1.73 m(2), RPF 344.1 ml/min/1.73 m(2)). A higher mean filtration fraction (FF) (GFR/RPF 0.36) was noted among those without ascites compared to those with ascites. Higher FF in patients without ascites is most likely secondary to the vasoconstriction in the efferent glomerular arterioles (normal FF ~0.20). In general, renal resistive indices were inversely related to FF. While patients with ascites had lower FF and higher right kidney main and arcuate artery resistive indices, those without ascites had higher FF and lower right kidney main and arcuate artery resistive indices. While cystatin C and β2-microglobulin performed better compared to Cr in estimating RPF, β-trace protein, β2-microglobulin, and SDMA, and (SDMA+ADMA) performed better in estimating right kidney arcuate artery resistive index. CONCLUSION: The results of this pilot study showed that identification of non-invasive biomarkers of reduced RPF and increased renal resistive indices can identify cirrhotics at risk for HRS at a stage more amenable to therapeutic intervention and reduce mortality from kidney failure in cirrhosis.
Authors: R Knapp; A Plötzeneder; F Frauscher; G Helweg; W Judmaier; D zur Nedden; W Recheis; G Bartsch Journal: J Ultrasound Med Date: 1995-06 Impact factor: 2.153
Authors: David J Wang; Thomas C Dowling; Dean Meadows; Tomas Ayala; Joanne Marshall; Stacey Minshall; Nancy Greenberg; Emil Thattassery; Michael L Fisher; Krishnamurti Rao; Stephen S Gottlieb Journal: Circulation Date: 2004-08-30 Impact factor: 29.690
Authors: R Rivolta; A Maggi; M Cazzaniga; D Castagnone; A Panzeri; D Solenghi; E Lorenzano; F Q di Palo; F Salerno Journal: Hepatology Date: 1998-11 Impact factor: 17.425
Authors: Ayse L Mindikoglu; Antone R Opekun; Nagireddy Putluri; Sridevi Devaraj; David Sheikh-Hamad; John M Vierling; John A Goss; Abbas Rana; Gagan K Sood; Prasun K Jalal; Lesley A Inker; Robert P Mohney; Hocine Tighiouart; Robert H Christenson; Thomas C Dowling; Matthew R Weir; Stephen L Seliger; William R Hutson; Charles D Howell; Jean-Pierre Raufman; Laurence S Magder; Cristian Coarfa Journal: Transl Res Date: 2017-12-12 Impact factor: 7.012
Authors: Ayse L Mindikoglu; Thomas C Dowling; Laurence S Magder; Robert H Christenson; Matthew R Weir; Stephen L Seliger; William R Hutson; Charles D Howell Journal: Clin Gastroenterol Hepatol Date: 2015-06-29 Impact factor: 11.382
Authors: Claire Francoz; François Durand; Jeffrey A Kahn; Yuri S Genyk; Mitra K Nadim Journal: Clin J Am Soc Nephrol Date: 2019-04-17 Impact factor: 8.237
Authors: Ayse L Mindikoglu; Antone R Opekun; William E Mitch; Laurence S Magder; Robert H Christenson; Thomas C Dowling; Matthew R Weir; Stephen L Seliger; Charles D Howell; Jean-Pierre Raufman; Abbas Rana; John A Goss; Saira A Khaderi; John M Vierling Journal: Dig Dis Sci Date: 2018-02-01 Impact factor: 3.199