Abstract To assess the sensitivity of duplex Doppler ul- trasonography in detecting early impairment of renal function in childhood cirrhosis, intrarenal arterial pul- satility index (PI) and resistive index (RI) were mea- sured in 10 ascitic and 11 non-ascitic children with liver cirrhosis and normal creatinine clearance and 10 age- and sex-matched controls. PI and RI were higher in as- citic than non-ascitic children [PI 1.54±0.4 vs. 1.1±0.2 (mean ± SD), P=0.006; RI 0.76±0.07 vs. 0.68±0.07, P=0.03). Non-ascitic patients had higher PI and RI than controls (P=0.002 and 0.0001, respectively). PI was in- versely correlated with creatinine clearance (r=–0.54, P=0.01). A significant positive relationship was ob- served between both PI and RI and Child score (r=0.47, P=0.009; r=0.45, P=0.01, respectively). However, no significant correlation was observed between PI and RI and portal hypertension. We conclude that renal vascular resistance indexes evaluated by duplex Doppler ultraso- nography are increased in the non-ascitic phase of cir- rhosis. Development of ascites is associated with a fur- ther increase in these indexes. The resistance indexes are best correlated with severity of hepatocellular dysfunc- tion, assessed by Child score, but not with portal hyper- tension. Hence, monitoring these indexes, especially PI, is a non-invasive means of studying early renal hemody- namic alteration in childhood cirrhosis. Key words Childhood cirrhosis · Renal hemodynamics · Duplex-Doppler ultrasonography Introduction Impaired renal perfusion plays a key role in sodium re- tention and fluid accumulation in liver cirrhosis [1, 2]. The derangement of renal perfusion reaches its extreme in hepatorenal syndrome; however these hemodynamic changes are already present in the early phase of cirrho- sis [3] when common kidney function tests are normal [4]. Serum creatinine and even creatinine clearance are not accurate indicators of renal impairment in patients with advanced liver cirrhosis [2]. Duplex Doppler waveform analysis is a non-invasive method for the evaluation of arterial tone. This method evaluates arterial resistance peripheral to a sampling site and has been used to predict early acute kidney rejection in patients who have undergone transplantation [5] and to differentiate obstructive from non-obstructive dilata- tion of the renal collecting system [6] or tubulointerstiti- al from glomerular renal diseases [7]. Non-invasive eval- uation of renal arterial resistance may be useful for both pathophysiological and clinical studies in cirrhosis. We performed this study to evaluate resistance indexes in children with different stages of cirrhosis without overt kidney failure. Patients and methods Twenty-one children (16 males, 5 females, aged 9.6±3.9 years) with pathology proven liver cirrhosis and normal kidney function were included. The patients were enrolled consecutively from the Pediatric Hepatology and Gastroentrology Unit, Mansoura Faculty of Medicine, Mansoura, Egypt, between June 1995 and January 1997. Ten of our patients were ascitic and 11 were non-ascitic. When the patients were assessed according to Child score, 5 pa- tients were class A, 8 were class B, and 8 were class C. All pa- tients had normal creatinine clearance. None of the patients had a recent history of gastrointestinal bleeding. No medications were given for at least 1 week prior to study. The characteristics of the studied groups are presented in Table 1. Ten age- and sex-matched children (7 males, 3 females, aged 9.6±2.8 years) without any evi- dence of renal or hepatic diseases served as controls. The study was approved by the ethics committee of Mansoura Faculty of Medicine. Informed consent was obtained from parents. A.F. Abdallah · A.M Bakr ( ✉ ) · M. El-Haggar Department of Pediatrics, Mansoura Faculty of Medicine, Mansoura, Egypt 35516 e-mail: ashbakr@mum.mans.eun.eg Tel.: +20-50-217744, Fax: +20-50-311170 T. Amer Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt Pediatr Nephrol (1999) 13:854–858 © IPNA 1999 ORIGINAL ARTICLE A.F. Abdallah · A.M. Bakr · M. El-Haggar · T. Amer Renal hemodynamic changes in children with liver cirrhosis Received: 2 September 1998 / Revised: 15 February 1999 / Accepted: 19 February 1999