Further Study into Obstructive Jaundice and Ischaemic Renal Damage

Abstract

Renal ischaemia for one hour in two groups of Gunn rats, one with and the other without bile-duct ligation, produced comparable reversible renal tubular lesions in both groups. Since Gunn rats have an unconjugated hyperbilirubinaemia, which is unaffected by bile-duct ligation, it seems likely that the high levels of bilirubin glucuronide are responsible for sensitizing the renal tubules to ischaemia, possibly by depressing cell respiration.

Association of hepatomegaly and jaundice with acute renal failure but not with cerebral malaria in severe falciparum malaria in Thailand.

“…Although renal failure itself may increase conjugated bilirubin, the significant increase of the conjugated bilirubin proportion among patients with jaundice with and without renal failure suggests that patients with jaundice and malaria had cholestasis. The linear relationship between renal failure and total bilirubin and studies on the renal consequences of obstructive jaundice 13 could therefore support a possible causal relationship.…”

“…3 Bilirubin in general is toxic for tubular cells, but it has been shown that patients with obstructive jaundice have a high risk of tubular necrosis when exposed to hypovolemia and hypoxia. 13 Here, patients with acute renal failure had hypoalbuminemia, which may have contributed to hypovolemia.…”

Evaluating role of oxidative stress in determining the pathogenesis of falciparum malaria induced acute renal failure

“…Both conjugated and unconjugated bilirubin and bile acid as well have been shown be involved in the pathogenesis of acute renal failure (20)(21)(22). In our study, seventy seven percent of patients in complicated (ARF) malaria had hyperbilirubinemia.…”

Outcome of malaria-associated acute kidney injury: a prospective study from a single center

“…23 Both conjugated and unconjugated bilirubin have been shown to be involved in the pathogenesis of acute renal failure in P. falciparum malaria. 24,25 In a previous study by Prakash et al, severe jaundice (serum bilirubin: 11.8-23.4 mg/dL) was observed in six (23%) patients, with biochemical evidence of cholestasis in all of them. 26 Cerebral symptoms were observed in 21.8% patients, similar observations have documented in past studies also.…”