• Antoine G Schneider, Anthony Schelleman, Mark D Goodwin, Michael Bailey, Glenn M Eastwood, and Rinaldo Bellomo.
• Intensive Care Unit, Austin Health , Heidelberg, Victoria , Australia .
• Ren Fail. 2015 Feb 1;37(1):175-9.

BackgroundTerlipressin 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.ObjectivesWe used CEUS to estimate the effect of terlipressin on the renal cortical microcirculation in type-1 HRS.MethodsWe 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.ResultsPatients 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.ConclusionsCEUS 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.

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