Indian Journal of Animal Research

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Research Article

Indian Journal of Animal Research, volume 54 issue 3 (march 2020) : 359-362

Hepatorenal arterial resistive and pulsatility indexes in dogs with ascites

Remzi Gonul1,*, Lora Koenhemsi1, Alper Bayrakal1, Kutay Yildiz1, Taner Bahceci1, Mehmet Erman Or1, Abdülkadir Uysal1
1Istanbul University Faculty of Veterinary Medicine, Department of Internal Medicine, 34890, Avcilar-Istanbul, Turkey.
Cite article:- Gonul Remzi, Koenhemsi Lora, Bayrakal Alper, Yildiz Kutay, Bahceci Taner, Or Erman Mehmet, Uysal Abdülkadir (2018). Hepatorenal arterial resistive and pulsatility indexes in dogs with ascites . Indian Journal of Animal Research. 54(3): 359-362. doi: 10.18805/ijar.B-960.

ABSTRACT

Ascites is one of the complications in cirrhosis. Prognosis depends on systemic hemodynamics. This study was designed for determination of the liver and kidney hemodynamics in dogs with ascites via Doppler Ultrasonography (USG). 20 dogs with ascites and 10 healthy dogs were included. CBC, biochemical profile, USG and Doppler measurement were taken. Increased hepatic and renal RI and PI were statistically significant (p<0,01-0,001). There were positive correlations between ALP and hepatic PI, between urea and renal RI, negative correlations between ALP and renal RI, between creatinine and hepatic and renal PI values (p<0,05-0,01). In conclusion, liver and kidney Doppler findings will help determination of the prognosis and implementation of effective treatment.

INTRODUCTION

The most common complication of cirrhosis is ascites, which may result either from severe portal hypertension or combination of moderately increased portal blood pressure and hypoalbuminemia (Arroyo and Colmenero, 2003; Sakamoto et al., 2012; Zhai et al., 2015). It is also reported that resistances to hepatic and renal arterial blood flows increases in cirrhotic patients (Rivolta et al., 1998b). The prognosis of patients with dilutional hyponatremia, refractory ascites and hepatorenal syndrome is extremely poor. Therefore, several studies have been carried out to determine both systemic hemodynamics and renal function for predicting the survival in humans (Arroyo and Colmenero, 2003; Sakamoto et al., 2012; Zhai et al., 2015). The occurrence of these diseases in dogs are unknown due to the absence of adequate studies in veterinary field (Lamb et al., 1999).
       
Blood tests, diagnostic imaging were used for diagnostic purpose. Although gray-scale ultrasonography (US) is widely used in these patients, little is known about the value of Doppler US (Rivolta et al., 1998b). Moreover, there is not any studies about intra hepatic arterial resistive index for determination of the hepatic arterial vascular resistance in dogs with ascites.
       
Therefore, the present study was planned in dogs to determine the clinical appearance of ascites and to improve the diagnosis of disease. For this purpose, the intra hepatic and intra renal vascular resistance were examined with Doppler ultrasound in dogs with ascites.

MATERIALS AND METHODS

In this study, 20 dogs with ascites and 10 healthy dogs of different breeds and ages (between 2-17 years, median age was 8.7 years) were included. All dogs were owner owned and brought to our clinic with enlargement of the abdomen for examination or treatment.
       
Physical examination, routine blood test (CBC and biochemical), ultrasound and Doppler examinations were performed on all dogs on the same day.
       
Doppler ultrasound was performed by using a SIUI Apogee 3500V Doppler ultrasound machine with a multifrequency microconvex transducer (4-10 MHz). The animals were fasted for 12h and kidneys and liver were scanned on right or left lateral recumbency. Color Doppler was used to visualize the intrarenal and hepatic vasculature (Fig 1). Subsequent pulse Doppler interrogation from one of the arteries was obtained with a sample width of 1.5-2 mm and a frequency of 5 MHz. The smallest scale that displayed the flow without aliasing was selected. Mean RI values for liver and each kidney were determined by averaging a total of three Doppler wave forms (Novellas et al., 2008). RI and PI values were obtained from interlobar, lobar and arcuate arteries in the kidneys and right hepatic arterial intrahepatic branch in the liver. Correction angel was under 60° (Fig 2).
 

Fig 1: Decreased liver size, hyperechoic areas and visualization of hepatic vascularisation with color Doppler ultrasonography in a dog with ascites.


 

Fig 2: Color Doppler visualization of hepatic vasculature and pulsed Doppler volume sample location in an intrahepatic branch of right hepatic artery in a dog with ascites.


       
Statistical analysis was performed using a statistical package for social sciences (SPSS computer package IBM, USA). The values of RI, PI, CBC and biochemical parameters of the animals with ascites were compared with the values of healthy dogs by Indipendent sample t-test. Also, a pearson correlation was applied to determine relation of RI and PI to hematological and biochemical parameters. Statistical significance was defined as p<0.05-0.01. The statistic methods based on the recommendations of Ekiz et al., (2014).

RESULTS AND DISCUSSION

6 dogs with ascites showed decreased liver size and many hyperechoic areas, 1 dog had tumour on the liver and all dogs had normal renal appearance in B-mode USG. Higher RI value (0.81±0.06) and PI value (1.45±0.32) in hepatic artery also increased renal RI value (0.67±0.07) and PI value (1.47±0.13) were detected in our study. Changes in Hepatic RI and Renal PI were statistically significant (p<0,01-0,001) (Table 1). Complete blood count and biochemical blood analyses have been showed in Table 1.
 

Table 1: CBC, biochemical parameters and blood velocity values in dogs with ascites and healthy dogs.


               
A negative correlation between serum ALP and renal RI and a positive correlation with ALP and hepatic PI was found. Also another hepatic biochemical parameter, serum GGT and hepatic PI and renal PI showed positive correlation. There was a positive correlation between serum urea and renal RI and between serum albumin and Hepatic PI and negative correlation between serum creatinine and hepatic PI and renal PI (p<0,05-0,01) (Table 2).
 

Table 2: Correlation between hepatic and renal Doppler measurements and related blood parameters.


       
Doppler findings can easily be measured in dogs and can give real time information on hemodynamics (Koda et al., 2000, Lamb et al., 1999, Sartor et al., 2010). Changes in liver and renal Doppler US variables were evaluated and compared in this study. RI and PI values are the most important indices that used for this. Koda et al., (2000) have demonstrated that renal RI and PI indices were increased in patients with ascites. These values may be used as early indicators of renal hemodynamic derangement and hepatorenal failure in dogs with ascites. Also Rivolta et al., (1998a) concluded that renal cortical RI was increased when ascites developed (no ascites 0.59±0.02 vs ascites 0.70±0.01) in cirrhotic patients. Novellas et al., (2008) and Ferrandis et al., (2013) had similar results and concluded renal arterial resistance was increased in cirrhotic patients with ascites. That was in agreement with these studies, the present study confirmed that the dogs with ascites had significantly increased levels of renal RI (0,67±0,07) and PI (1,47±0,13) values. Decreased vasopressor effect has been suggested as a possible cause of hypertension in animals and, it was postulated that this could also be the reason for the increased renal vascular resistance in the kidney (Novellas et al., 2008). In addition increased renal RI seemed to be correlated with a higher risk of deterioration in renal function in patients with refractory ascites even though with serum creatinine within the normal range (Popov et al., 2012).
       
RI is the major indicator of vascular resistance in Doppler studies of humans with hepatic disease (Lamb et al., 1999, Rivolta et al., 1998b, Sartor et al., 2010). However there was no consensus among researchers regarding the normal values of mean hepatic arterial RI in humans and animals. Paulson et al., (1996) determined this value as 0.62-0.69 and Rivolta et al., (1998a) 0.59±0.01 in humans. Lamb et al., (1999) concluded hepatic RI levels as 0.62-0.74 in dogs. The general appearance of hepatic wave forms is similar between humans and dogs, but specific wave velocities are different (Nelson et al., 2010). Hepatic arterial RI is the appropriate indicator of vascular resistance and useful for predicting the presence and severity of cirrhosis without affecting systemic blood pressure (Lamb et al., 1999, Zhai et al., 2015). Lamb et al., (1999) reported that, doppler measurements of hepatic artery vary with duration and severity for hepatic disease and common hepatic arterial RI value changed between the 0.69-0.79. Also Rivolta et al., (1998a) observed that, hepatic arterial RI value was significantly increased according to degree of portal hypertension (0.72±0.01 vs control: 0.59±0.01) in cirrhotic patients. We found higher RI (0.81±0.06) and PI (1.45±0.32) values in intrahepatic branch of right hepatic artery probably consequence of the vessel anatomy which was investigated first time for this purpose and severity of the disease in dogs with ascites.
       
Novellas et al., (2008) reported the positive correlation between the serum ALP and both RI and PI in dogs. Koda et al., (2000) reported correlation between other biochemical parameters like bilirubin, albumin, creatinine and both RI and PI in humans. However Popov et al., (2012) was not detected any correlation. A negative correlation between serum ALP and renal RI and positive correlation with hepatic PI was detected in our study. In addition serum GGT concentrations showed significant positive correlation with hepatic PI and renal PI. Also, in the present study there were a positive correlation between serum urea and renal RI and between serum albumin and Hepatic PI and a negative correlation between serum creatinine and hepatic PI and renal PI.
       
In our study, right hepatic arterial and renal RI and PI values were statistically significantly increased in all dogs with ascites (p<0.01- 0.001). In consideration of these informations, doppler ultrasound findings of the liver and kidney in dogs with ascites will help both determination of the clinical situation and implementation of effective treatment plans.

ACKNOWLEDGEMENT

The authors wish to acknowledge Research Fund of Istanbul University for supporting this research (Project number: BYP-19542).

REFERENCES


  1. Arroyo, V. and Colmenero J. (2003) Ascites and hepatorenal syndrome in cirrhosis: pathophysiological basis of therapy and current management. J. Hepatol., 38(Suppl 1):69-89.

  2. Ekiz, B., Yilmaz, A., Yakan, C. and Hanoglu, H. (2014) Finishing performance and meat fatty composition of Hair goat and Saanen X Hair goat crossbred (F1 and B1) kids. Istanbul Univ. Vet. Fak. Derg, 4: 226-236.

  3. Ferrandis, I., Jakovljevic, S., Aprea, F. and Corletto, F. (2013) Effect of two sedative protocols and hepatosplenic disease on Doppler indices of splenic arterias in dogs: A preliminary study. Vet. J., 197: 712-716.

  4. Koda, M., Murawaki, Y. and Kawasaki, H. (2000) Renovascular resistance assessed by color Doppler ultrasonography in patients with chronic liver diseases. J. Gastroenterol. Hepatol., 15: 1424-1429.

  5. Lamb, C. R., Burton, C. A. and Carlisle, C. H. (1999) Doppler measurement of hepatic arterial flow in dogs: Technique and preliminary findings. Vet. Radiol. Ultrasound., 40: 77-81.

  6. Nelson, N. C., Drost, W. M. T., Lerche, P. and Bonagura, J. D. (2010) Noninvasive estimation of central venous pressure in anesthetized dogs by measurement of hepatic venous blood flow velocity and abdominal venous diameter. Vet. Radiol. Ultrasound., 51: 313-323.

  7. Novellas, R., De Gopegui, R. R. and Espada, Y. (2008) Increased renal vascular resistance in dogs with hepatic disease. Vet. J., 178: 255-260.

  8. Paulson, E. K., Kliewer, M. A., Frederick, M. G., Keogan, M. T., Delong, D. M. and Nelson, R.C. (1996) Hepatic artery: Variability in measurement of resistive index and systolic acceleration time in healthy volunteers. Radiology, 200: 725-729.

  9. Popov, D., Krasteva, R., Ivanova, R., Mateva, L. and Krastev, Z. (2012) Doppler parameters of hepatic and renal hemodynamics in patients with liver cirrhosis. International Journal of Nephrology., 2012: 1-9.

  10. Rivolta, R., Vigna, L., Scaramuzza, D., Cardinale, L. and Gelimann, E. (1998a) Utility of resistive index in the follow up of cirrhosis and portal hypertension. Eur. J. Ultrasound., (Sup 1): 51.

  11. Rivolta, R., Maggi, A., Cazzaniga, M., Castagnone, D., Panzeri, A., Solenghi, D., Lorenzano, E., Quarto, D. I., Palo, F. and Salerno, F. (1998b) Reduction of renal cortical blood flow assessed by doppler in cirrhotic patients with refractory ascites. Hepatology, 1998b 28(5): 1235-1240.

  12. Sakamoto, Y., Sakai, M. and Watari, T. (2012) Three minimally invasive methods of measuring of portal vein pressure in healthy dogs. J. Vet. Med. Sci.,74: 1299-1302.

  13. Sartor, R., Mamprim, M. J., Takahira, R. F. and Almeida, M. F. (2010) Hemodynamic evaluation of the right portal vein in healthy dogs of different body weights. Acta. Vet. Scand., 52: 36-41.

  14. Zhai, L.,Qiu, L. Y., Zu, Y., Yan, Y., Ren, X. Z., Zhao, J. F., Liu, Y. J., Liu, J. B. and QIAN, L. X. (2015) Contrast enhanced ultrasound for quantitative assessment of portal pressure in canine liver fibrosis. World. J. Gastrenterol., 21: 4509-4516. 
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