Renal failure in obstructive jaundice—clinical aspects

Dawson, J. L.

doi:10.1136/pgmj.51.598.510

Cited by 7 publications

(4 citation statements)

References 5 publications

(7 reference statements)

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“…The association between obstructive jaundice and acute renal failure (ARF) is well-recognized; ARF may develop in patients with jaundice caused either by operation or septicemia (or both), but is rarely described [ 25 ]. Bismuth et al (1975) reported an association between AC and ARF in a large-scale trial [ 24 ], which included 283 hospitalized patients with confirmed cholangitis.…”

Section: Discussionmentioning

confidence: 99%

“…AKI according to the guidelines is defined as any of the following: Increase in serum creatinine (SCr) by X0.3 mg/dl within 48 hours; or Increase in SCr to X1.5 times baseline, which is known or presumed to have occurred within the prior 7 days; or Urine volume 0.5 ml/kg/h for 6 hours. Although two very old studies on renal failure associated with AC have appeared [ 24 , 25 ], no study has applied the KDIGO guidelines to evaluate the incidence, risk factors, or clinical outcomes of AKI in association with AC, which was the goal of this study.…”

Section: Introductionmentioning

confidence: 99%

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Incidence, risk factors, and prognosis of acute kidney injury in hospitalized patients with acute cholangitis

et al. 2022

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Background The association between acute cholangitis (AC) and acute kidney injury (AKI) remains unclear. We investigated the incidence, and clinical course of AKI in patients with AC, and the long-term prognosis. Methods We performed a single-center retrospective study of patients hospitalized with AC in a tertiary care center from January 2011 to December 2017. The risk factors for AKI were evaluated, and AKI severity was analyzed using the Systemic Inflammatory Response System (SIRS), quick sequential organ failure assessment (qSOFA) score, and 2018 Tokyo Guidelines (TG) grade. To calculate the relative risk of death based on AKI, hazard ratios (HRs) and 95% confidence intervals (CIs) were obtained using Cox’s proportional hazard models. Results A total of 1,438 patients with AC were included, of whom 18.2% (n = 261) developed AKI. AKI patients were older, and had a lower systolic blood pressure and more comorbidities including hypertension (HT), chronic kidney disease, and cardiovascular accidents. Disease severity (as assessed by SIRS, qSOFA, and the Tokyo Guidelines grade) was higher in the AKI group, as was the in-hospital mortality rate. Multivariate analysis revealed that age, HT, SIRS and qSOFA scores ≥ 2, and TG grade of III were significant risk factors for AKI. Kaplan-Meier analysis revealed significantly higher mortality in the AKI than non-AKI group. AKI (HR = 1.853; 95% CI: 1.115–3.079) and TG grade III (HR = 2.139; 95% CI: 1.190–3,846) were independent predictors of all-cause AC mortality, even after adjusting for all covariates. The annual rate of decline in the estimated glomerular filtration rate was faster in the AKI than non-AKI group (2.9 ± 6.7 vs. 0.5 ± 5.3 mL/min/1.73 m2/year, p < 0.001). Conclusions AKI development increased AC severity and mortality. Our results suggest that clinicians should monitor AKI status and perform appropriate management as soon as possible.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incidence, risk factors, and prognosis of acute kidney injury in hospitalized patients with acute cholangitis

et al. 2022

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“…Obstructive jaundice may be a life-threatening condition due to the interplay of various factors: ascending cholangitis (Boey & Lawrence 1980), acute renal failure (Dawson 1975), hampered defence mechanisms with poor antibiotic penetration (Dawson 1981), high serum fibrinogen/fibrin degradation products (Allison et al 1979), and peripheral and portal endotoxaemia (Bailey 1976). Biliary decompression is therefore important, as well as being necessary to relieve the attendant unpleasant symptoms.…”

Section: Introductionmentioning

confidence: 99%

Surgical Relief of Obstructive Jaundice in a District General Hospital

Al-Fallouji¹,

Collins²

1985

J R Soc Med

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Summary: Fifty consecutive patients with obstructive jaundice treated by operation in Canterbury & Thanet Health District hospitals under the care of one surgeon (RECC) over a 6-year period have been studied. The pathology was found to be common bile duct (CBD) stone in 22 patients (44%); pancreatic carcinoma in 15 (30%), 3 of whom also had CBD stones; chronic pancreatitis in 4 (8%); extrahepatic CBD carcinoma in 4 (8%); ampulla of Vater carcinoma in 3 (6%); primary duodenal carcinoma in 1 (2%); and portahepatis obstruction in 4 (8%). The 8 postoperative deaths (16%) were found to be associated with high preoperative levels of serum bilirubin, but all occurred in patients with malignant disease. Complications occurred in 20 patients (40%) and bile culture state was found to be intimately related to the morbidity rather than operative mortality. The study represents a careful audit of the pathology distribution and the surgical management of obstructive jaundice as seen in district hospitals.

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“…Clinical studies have shown that patients with obstructive jaundice, are unable to tolerate even moderate hemorrhage [6,25], There is evidence indicating that the functional reserve of the liver in jaundiced patients or animals depends on the mitochondrial oxidative phosphorylation activity [17], and pronounced derangement of liver mitochondria has been found to occur, with progressive deterioration of the patients' clinical status [16]. It has also been reported that jaundiced animals in which impairment of the liver mitochondria is likely to occur are particularly susceptible to irrevers ible hemorrhagic shock [21], In order to elucidate the possible causes of the impairment of the hepatic energy status in jaundiced animals subjected to hemorrhagic hypo tension, changes in plasma proteins and hematocrit (Ht) are analyzed, and the effects on circulatory disturbances are discussed in comparison with changes in ATP.…”

Section: Introductionmentioning

confidence: 99%

Effect of Hypovolemic Hypotension on Plasma Proteins and Hepatic Energy Status in Jaundiced Rabbits

Yamamoto¹,

Ozawa

Tobe

et al. 1982

Eur Surg Res

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Changes in plasma proteins and hematocrit (Ht) were studied in jaundiced rabbits subjected to hemorrhagic hypotension induced by the modified method of Wiggers and compared with changes in the hepatic energy status. At 48 h after common bile duct ligation, jaundiced rabbits showed hypoalbuminemia and a lower hepatic energy charge (EC), (ATP+1/2ADP)/(ATP+ADP+AMP). 30 min after induction of hypovolemic hypotension, in order to maintain a mean arterial pressure of 40 mm Hg, 86% of the blood collected in the reservoir (about 19 % of the normal whole blood volume) had to be successively reinfused over a 2-hour period. Despite increases in Ht and plasma total protein (p-TP) occurring in parallel with the reinfusion, plasma albumin (p-Alb) and the ratio of p-Alb to plasma globulin (A/G) did not increase. On the other hand, in sham-operated rabbits small amounts of blood had to be frequently removed during the first hour (about 34% of the normal whole blood volume), and only 34% of it had to be reinfused over a 2-hour period. Despite removal of more blood and a concomitant decrease in Ht, p-Alb and A/G ratio were higher than in jaundiced rabbits. After marked decreases in EC and total adenine nucleotides (TAN) due to the initial blood loss, EC recovered somewhat and remained higher in sham-operated rabbits than in jaundiced rabbits, whereas TAN did not recover in either group. This seems to indicate that hemodilution functions effectively to maintain microcirculation following hemorrhagic hypotension in sham-operated rabbits, while in jaundiced rabbits a rapid breakdown of protective homeostatic mechanisms results in the earlier deterioration of the hepatic energy status.

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Renal failure in obstructive jaundice—clinical aspects

Cited by 7 publications

References 5 publications

Incidence, risk factors, and prognosis of acute kidney injury in hospitalized patients with acute cholangitis

Incidence, risk factors, and prognosis of acute kidney injury in hospitalized patients with acute cholangitis

Surgical Relief of Obstructive Jaundice in a District General Hospital

Effect of Hypovolemic Hypotension on Plasma Proteins and Hepatic Energy Status in Jaundiced Rabbits

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