The incidence of postoperative renal failure in obstructive jaundice

Bile Acid-Induced Cholemic Nephropathy

“…The association between obstructive jaundice and kidney injury is a well-known clinical phenomenon and unresolved problem [26,27,28]. The kidney alterations in obstructive jaundice became known as ‘cholemic nephropathy (CN)', an umbrella term describing renal dysfunction in jaundiced patients with characteristic histomorphological findings on kidney histology.…”

Präoperatives Gallengangstenting

“…Das alles sind Folgen des Stauungsikterus, der weit schneller fortschreitet als die zugrundeliegende Erkrankung und unbehandelt viel fru È her zum Tod des Patienten fu È hrt als das Karzinom selbst. Parallel mit der Verschlechterung der Gesamtsituation des Patienten nehmen die Risiken einer chirurgischen Behandlung zu [1,2]. Umgekehrt sollte die Beseitigung der Gallestauung zur Ru È ckbildung des Ikterus und zur Besserung der u È brigen Befunde fu È hren, wodurch ein gu È nstiger Einfluû auf die Komplikationsrate erwartet werden kann.…”

Renal failure in obstructive jaundice—clinical aspects

“…In a survey of 107 patients undergoing operation for the relief of obstructive jaundice, seven deaths were due to acute renal failure (Dawson, 1965); this incidence is many times that anticipated in a comparable group of non-jaundiced patients. The deeper the jaundice the greater the risk, thus six of the seven deaths occurred in patients whose immediate preoperative bilirubin was over 20 mg %.…”

“…The results showed that the presence of obstructive jaundice sensitizes the renal parenchyma to damage by ischaemia. A solute diuresis (using mannitol), initiated before the renal clamping, offered considerable protection -in the experimental animals (Dawson, 1965). Later, comparable experiments in Gunn rats (a species unable to conjugate bilirubin) showed no difference between those animals with and those without their bile ducts ligated (Baum, Stirling and Dawson, 1969).…”