The effect of preoperative bile salt administration on postoperative renal function in patients with obstructive jaundice

Abstract

We have studied the effect of the preoperative administration of bile salts on postoperative renal function in jaundiced patients undergoing surgery. Nine patients did not receive bile salts and in this group there were 2 cases of acute renal failure in the postoperative period. Furthermore, creatinine clearance values fell in this group from a mean value of 85 ml/min preoperatively to a mean postoperative value of 55 ml/min. Nine patients received preoperative bile salts with no case of renal failure. Creatinine clearance values increased in all but 2 patients from a mean preoperative value for the group 79 ml/min to a mean postoperative value for the group of 99 ml/min. The difference between the changes in creatinine clearance in the two groups was statistically significant (P less than 0.01). The results of this study suggest that the oral administration of bile salts to jaundiced patients in the preoperative period prevents deterioration in renal function postoperatively and also reduces the incidence of postoperative renal failure.

Regulation of antibacterial defense in the small intestine by the nuclear bile acid receptor

“…Oral administration of bile acids inhibits the bacterial overgrowth and translocation caused by biliary obstruction in rodents (3,4). Moreover, preoperative oral administration of bile acids blocks endotoxemia in patients with obstructive jaundice (5)(6)(7). The mechanisms underlying the beneficial actions of bile acids are not known.…”

The Role of Bile and Bile Acids in Bacterial Translocation in Obstructive Jaundice in Rats

“…Endotoxaemia has been thought to be the major cause of renal impairment in ob structive jaundice due to lack of gastro-intes tinal bile flow [5,6], The predominantly iso-lated pathogenic micro-organisms in sepsis following biliary tract surgery in patients with obstructive jaundice are enteric gram-nega tive bacteria [7,8]. The mechanisms by which enteric bacteria reach the infectious focus (wound, abscess, bile or various organs) in obstructive jaundice are not entirely eluci dated.…”

Effects of percutaneous transhepatic biliary drainage on renal function in patients with obstructive jaundice

“…However, decreases in creatinine clearance were significantly greater in the jaundiced patients and correlated directly with serum bilirubin levels. In a study of nine patients with obstructive jaundice, Evans et al (33) reported a decrease in postoperative creatinine clearance from a mean of 85 mL/min to 55 mL/min. Thirty days after PTBD, mortality is >10% in many malignant obstruction studies, but this is largely due to underlying diseases (1).…”