title: Contrast-enhanced ultrasound evaluation of the renal microcirculation response to terlipressin in hepato-renal syndrome: a preliminary report.
abstract: BACKGROUND
  Terlipressin improves renal function in some patients with type-1 hepato-renal syndrome (HRS). Renal contrast-enhanced ultrasound (CEUS), a novel imaging modality, may help to predict terlipressin responsiveness.
  
  
  OBJECTIVE
  We used CEUS to estimate the effect of terlipressin on the renal cortical microcirculation in type-1 HRS.
  
  
  METHODS
  We performed renal CEUS scans with destruction-replenishment sequences using Sonovue(®) (Bracco, Milano Italy) as a contrast agent at baseline and after the intravenous administration of 1 mg of terlipressin, in four patients with type-1 HRS. We analyzed video sequences offline using dedicated software. We derived a perfusion index (PI) at each time point for each patient.
  
  
  RESULTS
  Patients 1 and 2 had severe presentation and were admitted to the intensive care unit. Both showed a marked increase in PI (+216% and + 567% of baseline) in response to terlipressin. Patients 3 and 4 had less severe presentations and had a decrease in PI (-53% and -20% of baseline) in response to terlipressin. Patients 1, 2, and 4, but not patient 3, responded to terlipressin therapy with a decrease in serum creatinine to <150 µmol/L.
  
  
  CONCLUSIONS
  CEUS detected changes in renal cortical microcirculation in response to terlipressin and demonstrated heterogeneous microvascular responses to terlipressin. These initial proof-of-concept findings justify future investigations.
authors.affiliation: Intensive Care Unit, Austin Health , Heidelberg, Victoria , Australia .
authors.forename: Antoine G
authors.initials: AG
authors.lastname: Schneider
authors.forename: Anthony
authors.initials: A
authors.lastname: Schelleman
authors.forename: Mark D
authors.initials: MD
authors.lastname: Goodwin
authors.forename: Michael
authors.initials: M
authors.lastname: Bailey
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Eastwood
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D061605:Administration, Intravenous; D000959:Antihypertensive Agents / Q000008:administration & dosage; D006530:Hepatorenal Syndrome / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007672:Kidney Cortex / Q000098:blood supply / Q000000981:diagnostic imaging; D008236:Lypressin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008297:Male; D008833:Microcirculation / Q000187:drug effects*; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods*; D012720:Severity of Illness Index; D000077585:Terlipressin; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000959:Antihypertensive Agents; D008236:Lypressin; D000077585:Terlipressin
keywords: Contrast-enhanced ultrasonography; hepato-renal syndrome; microcirculation; renal perfusion; terlipressin