Impact of Different Modalities of Treatment of Hepatorenal Syndrome as Midodrine, Somatostatin analogue, Albumin infusion and Tapping of Ascites on Renal Artery Resistive Index by Doppler ultrasound

Abstract

Liver cirrhosis is a major cause of morbidity and mortality worldwide, mainly due to complications of portal hypertension. Ascites formation in patients with cirrhosis, portal hypertension, or both usually results from hyperdynamic circulatory dysfunction. The hepatorenal syndrome (HRS) is a well-recognized complication of advanced cirrhosis Renal hemodynamic measurements including increased renal resistive indices are complicated to perform in patients with cirrhosis, yet they related to the development of HRS.

The initial treatment of choice in patients with refractory ascites is large-volume paracentesis (LVP) associated with intravenous albumin. Midodrine and octreotide are used for the management of hypotension.

The present study aimed to investigate the effect and prognostic value of treatment of hepatorenal syndrome in patients with liver cirrhosis and massive ascites by LVP, somatostatin analogue and midodrine intake and its effect on renal resistive index.

This study was carried on 40 patients divided into 4 groups where 10 patients (G1) received midodrine therapy and albumin infusion, 10 patients (G2) had tapping of ascites with albumin infusion, 10 patients (G3) received octreotide therapy and albumin infusion and the last 10 patients (G4) received octreotide, midodrine and albumin infusion.

All patients were subjected to careful history taking and thorough clinical examination. Before and after intervention, patients had laboratory investigation including complete blood picture, liver function tests, renal