Renal blood flow before and after portosystemic shunt in children with portal hypertension

Abstract

Introduction: Variceal haemorrhage in children with extrahepatic portal hypertension is best controlled by an effective decompressive shunt, but long-term follow up of children who have had splenorenal shunt due to extrahepatic portal hypertension (EHPH) gave evidence for assuming the risk of renal venous hypertension (RVH).

Purpose: To study renal hemodynamic before and after portal decompression.

Methods: The results of 144 portosystemic shunt operations were followed from 2005 to 2013. Seventy-two patients applied central splenorenal shunt (CSS) with splenectomy, ten side-to-side splenorenal shunt without splenectomy (SRSss), ten patients assessed the distal splenorenal shunt (DSS). Forty-three iliacomesenterial anastomosis (IMA) and in nine cases performed mesocaval anastomosis (MCA). Children had a standard pre- and postoperative work up including gastrointestinal endoscopy, Doppler ultrasonography (US), multi-slice computed tomography (MSCT) and renography.

Results: In 11 (15.2 %) patients after CSS on duplex, Doppler study revealed signs of impeded venous outflow on the left renal vein (LRV). At long-term follow-up PI and RI of left renal artery remained at high numbers (1.48 ± 0.17 and 0.72 ± 0.19, p ≤ 0.05, respectively) after the CSS. Venous blood flow in the LRV at the hilum showed slower speed performance in groups of CSS and after IMA. After DSS, these signs have not been detected. Four patients after IMA on US Doppler and CT angiography revealed dilated left testicular and ovarian veins, with retrograde blood flow in them, which clinically manifested as left flank pain, macro- and microhematuria, varicocele and ovaricocele.

Conclusion: The study shows that CSS and IMA more negatively effect on hemodynamics of left kidney and symptoms of RVH obviously due to shunting the large amounts of blood from a system of high pressure to a low.