EVect of meal induced splanchnic arterial vasodilatation on renal arterial haemodynamics in normal subjects and patients with cirrhosis

Aims—To investigate the relation between changes in splanchnic arterial haemodynamics and renal arterial haemodynamics in controls and patients with cirrhosis. Methods—Superior mesenteric artery pulsatility index (SMA-PI) and renal artery pulsatility index (R-PI) were measured using Doppler ultrasonography in 24 controls and 36 patients with cirrhosis. These measurements were repeated 30 minutes after ingestion of a liquid meal or placebo. Sixteen controls and 24 patients received the meal, and eight controls and 12 patients received placebo. Results—In the fasting condition, patients with cirrhosis had a lower SMA-PI (p<0.01) and a greater R-PI (p<0.01) compared with controls. Placebo ingestion had no eVect on splanchnic and renal haemodynamics. In contrast, ingestion of the meal caused a notable reduction in SMA-PI (p<0.01, p<0.01) and an increase in R-PI (p<0.01, p<0.01) in controls and patients with cirrhosis. The meal induced haemodynamic change in SMA-PI was inversely correlated with that in R-PI in controls (t=−0.42, p<0.05) and in patients with cirrhosis (t=−0.29, p<0.05). Conclusions—Results support the hypothesis that renal arterial vasoconstriction seen in patients with cirrhosis is one of the kidney’s homoeostatic responses to underfilling of the splanchnic arterial circulation. (Gut 1998;43:843–848)