Jaundice and Anoxic Renal Damage: Protective Effect of Mannitol

Abstract

Surgical operations on deeply jaundiced patients are complicated by acute renal failure more often than comparable operations on non-jaundiced patients (Clairmont and Von Haberer, 1911;Aird, 1953 ;Zollinger and Williams, 1956). Considerable decreases in renal blood-flow have been shown to occur with traction on viscera during abdominal operations (de Wardener, 1955) or in shock (Lauson et al., 1944). It is possible that obstructive jaundice renders the kidney more sensitive to decreased blood-flow-that is, anoxia.Experiments were therefore carried out to test this hypothesis. Using unilaterally nephrectomized rats, the effect of clamping the remaining renal pedicle for 60 minutes was compared in jaundiced and non-jaundiced animals. Furthermore, observations were made on the effect of a mannitol diuresis on such a clamping in jaundiced rats.after the clamping a further 15 ml. of 10% mannitol was given intraperitoneally.In preliminary studies on unilaterally nephrectomized rats, using intraperitoneal injections, it was established that 5 ml. of 10% mannitol initiated a diuresis within four hours, and 15 ml. of 10% mannitol raised the urine output from between 7 and 14 ml. up to 25 to 30 ml.In all groups only those animals recovering from the pentobarbitone anaesthesia of the third operation were included in the final results.Blood samples (0.7 ml.) were taken from the tail vein immediately before the clamping operation for estimation of blood urea and bifirubin. On the first, second, third, fifth, and seventh post-operative days further samples (0.2 ml.) of tail-vein blood were taken for blood-urea estimation. The Scheme of experiments performed.The right kidney was removed in all animals. A second operation was carried out two days later. In the control animals, groups I and II, the common bile-duct was exposed but not ligated. In groups III, IV, and V the common bile-duct was ligated and divided to produce obstructive jaundice. For these operations ether anaesthesia was used.Seven days later, under intraperitoneal pentobarbitone sodium anaesthesia, the left renal pedicle was exposed. In groups I and III a bulldog clamp was laid alongside, but not occluding, the pedicle for 60 minutes. In groups II and IV the left renal pedicle was clamped with a bulldog clamp for 60 minutes.In group V the left renal pedicle was clamped for 60 minutes, but four hours before this operation an osmotic diuresis was started using 5 ml. of 10% mannitol intraperitoneally. After the clamping operation was completed a further 10 ml. of I0% mannitol was injected intraperitoneally. At 24 and 48 hours

Cholestatic liver disease modulates susceptibility to ischemia/reperfusion-induced arrhythmia, but not necrosis and hemodynamic instability: The role of endogenous opioid peptides

“…Cardiovascular abnormalities are among well-known complications of acute and chronic liver diseases, mostly studied in cholestasis [1][2][3][4][5][6][7][8][9][10][11][12] and cirrhosis [13,[29][30][31][32][33], respectively. These abnormalities can be categorized into basal complications, such as heart rate abnormalities [3][4][5], hypotension [1,2] and electrophysiological changes [34,35]; and abnormalities which manifest as inadequate response to stressful stimuli, including blunted chronotropic [3][4][5], inotropic [31] and vasoconstrictor response to adrenergic stimulation [1,2,9].…”

“…It is well known that cholestatic liver disease is associated with hypotension [1,2], bradycardia [3][4][5], QT prolongation [6], hyporesponsiveness of cardiovascular system to adrenergic stimulation [7][8][9], and tendency to hypovolemic shock and acute renal failure [10][11][12]. QT prolongation usually increases vulnerability to arrhythmia in congenital and acquired conditions [13].…”

Effect of Chronic Bile Duct Obstruction on Renal Handling of Salt and Water

“…Evidence also exists suggesting that obstructive jaundice may increase the risk of postoperative acute renal failure in humans (11), and it may predispose the kidney to ischemic damage in rodents (1,2). In these studies, however, the various parameters of renal function during obstructive jaundice were not evaluated.…”

“…Available data indicate that liver damage may affect renal function (1)(2)(3). Enhanced renal tubular sodium reabsorption, impaired renal concentrating ability, and abnormal water diuresis have been reported in patients with cirrhosis of the liver (4)(5)(6)(7)(8), and liver failure may be associated with renal failure as in the hepatorenal syndrome (9,10).…”

Renal Failure in Malaria: A Pathophysiologic Study

“…In our ex perience renal failure with hyperbilirubinemia over 25 mg/100 ml responds well to exchange transfusion [24]. The decrease in serum bili rubin is accompanied by the increase in urine flow and the improvement of renal function, suggesting the adverse effect of jaundice on the renal function, a viewshared by several authors [25][26][27], In the present study with the serum bilirubin ranging from 4.0 to 20.2 mg/100 ml there was no correlation between the severity of renal failure and the level of serum bilirubin. We do not feel that jaundice of this degree plays any role in the pathogenesis of malarial failure.…”