Value of shear wave elastography in predicting hepatorenal syndrome in patients with liver cirrhosis and ascites

Abstract

Acute renal impairment is a common complication in patients with liver cirrhosis and is associated with high rates of morbidity and mortality. Patients usually present acute kidney injury (AKI) without renal structural changes. The major causes of AKI include prerenal, intrinsic/parenchymal disorders, obstructive nephropathy and hepatorenal syndrome (HRS). 1-3 Among these, HRS is a special form of renal impairment characterised by rapid progression and poor prognosis. It is reported that HRS has an extremely poor prognosis with 3-month mortality as high as 80%. 4 Therefore, early detection of renal damage in cirrhosis is critical to prevent HRS. There is a lack of methods to evaluate renal function and predict HRS, and the diagnosis mainly depends on exclusion. Serum creatinine, neutrophil gelatinase-associated lipocalin (NGAL), and cystatin C (CystC) are the most common markers used to monitor kidney function, but

Seeing and Sensing the Hepatorenal Syndrome (HRS): The Growing Role of Ultrasound-Based Techniques as Non-Invasive Tools for the Diagnosis of HRS

“…The authors found that decreased baseline renal stiffness can predict kidney injury in patients with advanced liver disease and ascites alongside increased serum cystatin C, urinary NGAL, and RARI. In this study, the combination of SWE and the renal artery resistive index improved the ability to predict the occurrence of HRS, with an AUROC of 0.89 [79].…”

“…14, x FOR PEER REVIEW 10 of 14 combination of SWE and the renal artery resistive index improved the ability to predict the occurrence of HRS, with an AUROC of 0.89[79].…”

Renal resistive index measurements by ultrasound in patients with liver cirrhosis: Magnitude and associations with renal dysfunction

“…Such differentiation is crucial not only for guiding optimal treatment decisions but also for avoiding unnecessary volume expansion and the adverse effects of vasoconstrictor medication. While many studies have shown higher RRI values in HRS patients compared to non-AKI patients, there is a lack of studies focusing on RRI’s performance in ATN-AKI scenarios[ 7 - 9 ]. For instance, a small study by Maroto et al [ 8 ] reported significantly higher RRI in AKI patients compared to non-AKI patients (mean RRI: 0.74 vs 0.64).…”

“…Patients with advanced cirrhosis often exhibit elevated RRI due to renal vascular constriction. Some studies have explored the utility of RRI in assessing renal dysfunction in cirrhosis patients, particularly in determining whether AKI is structural or functional[ 7 , 8 ]. Fang et al [ 7 ] observed higher RRI values in patients with HRS compared to those with ATN.…”

“…Some studies have explored the utility of RRI in assessing renal dysfunction in cirrhosis patients, particularly in determining whether AKI is structural or functional[ 7 , 8 ]. Fang et al [ 7 ] observed higher RRI values in patients with HRS compared to those with ATN. However, there is limited research on RRI’s ability to distinguish between ATN-AKI and other phenotypes[ 9 ].…”