I. Renal Function Influenced by Intestinal Obstruction

Abstract

Associated with the intoxication of intestinal obstruction there exists a definite impairment of the excretory function of the kidneys. The degree of functional depression corresponds roughly with the intensity of the clinical intoxication. The decrease in the urea ratio and in the capacity of the kidneys to excrete sodium chloride is more marked than is the percentage decrease of phenolsulfonephthalein elimination. The great increase in the non-protein nitrogen of the blood usually observed in acute intestinal obstruction, which has hitherto been explained as being due entirely to an increased rate of protein catabolism, is due in part to retention of the products released from the injured cell protein. It is probable that the impaired renal function is due to direct action of the toxic substances upon the renal epithelium. The actual demonstration of this renal injury is perhaps the strongest evidence so far obtained to prove the presence of an actual toxic substance in the blood during intestinal obstruction. This obscure disability of the kidneys during the height of the intoxication of acute ileus should always be considered in the clinical management of this condition. It may also serve as a guide to indicate the degree of intoxication.

Ii. Renal Function Influenced by Proteose Intoxication

“…This involvement of the renal function is similar to that shown by the preceding report (1) to accompany the intoxication of intestinal obstruction.…”

“…There appears to be produced by these toxic substances a l~rimary injury of the secreting cells of the kidney itself which is responsible for the greater part of the impairment as was pointed out in the preceding communication (1), although this injury is not demonstrable by the ordinary histological technique. As far as we are aware this is one of the first instances observed in which a marked kidney injury or impaired function has been demonstrated, followed very quickly by repair and a return to normal, associated with no trace of permanent injury.…”

“…In the preceding paper (1) we reported a number of experiments which showed that the excretory function of the kidneys is definitely impaired during the intoxication of intestinal obstruction. Since most of the animals employed in that study died late during the night, the maximum degree of impairment was not always ascertained by the tests made on the previous day.…”

Experimental Dehydration: Chemical Changes in the Blood of the Dog Contrasted With Those Following Obstruction of the Cardiac End of the Stomach

“…The viscosity is much increased (8) with necessarily an accompanying decrease in volume flow. The oxygen capacity is decreased (9) and renal function is impaired (10). Long ago Spiegler (11) and others demonstrated an increased nitrogen excretion after water deprivation due to accelerated protein breakdown.…”

The Excretion of Nitrogen After Upper Gastrointestinal Tract Obstruction

“…The explanation for this change is not entirely clear. Whipple, Cooke and Stearns found an increase in nitrogen excretion in the dog after intestinal obstruction (3), and no marked evidence of renal insufficiency (4). They attributed the heaping up of non-protein nitrogen in the blood to accelerated protein destruction caused by some toxic body arising in the wall of the obstructed gut.…”