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Pinter K, Rosenkranz A. Cholemic Nephropathy: Role in Acute Kidney Injury in Cholestasis and Cirrhosis. ADVANCES IN KIDNEY DISEASE AND HEALTH 2024; 31:111-126. [PMID: 38649215 DOI: 10.1053/j.akdh.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 06/28/2023] [Accepted: 07/12/2023] [Indexed: 04/25/2024]
Abstract
The concept of structural kidney damage and renal dysfunction as a result of jaundice attracted attention in the medical community in the early and mid-20th century. The postulated doctrine of the time was that the excretion of elevated concentrations of bile results in bile-stained casts occupying collecting and distal convoluted tubules, degeneration of tubular epithelium, and decreased renal function. Compared to the hepatorenal syndrome, the poster child of hepatology and nephrology collaboration, the notion of structural kidney damage and renal dysfunction as a result of cholemia lost its traction and has almost disappeared from modern textbooks. Today, cholemic nephropathy is experiencing a renaissance, with multiple case reports and case series of jaundiced patients with kidney dysfunction and evidence of bile acid casts upon histologic examination. Published cases include acute hepatitis, chronic liver injury, cirrhosis, and obstructive etiologies. Diagnosis of cholemic nephropathy is based on histological examination, typically showing intraluminal bile casts predominantly located in the distal tubules. In common bile duct-ligated mice, the histomorphological and functional alterations of cholemic nephropathy mimic those seen in humans. Some argue against the concept of cholemic nephropathy and postulate that bile casts are a secondary phenomenon. What we need are carefully designed trials to establish diagnostic criteria and subsequently translate this knowledge into evidence-based therapies.
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Gautam A, Kumar S, Madhavan SM, Choudhary D, Jha S, Pandey A, Masood S, Chauhan S. Percutaneous Transhepatic Biliary Drainage Improves Quality of Life in Advanced Gallbladder Cancer with Obstructive Jaundice: a Holistic Assessment. Indian J Surg Oncol 2021; 13:384. [DOI: 10.1007/s13193-021-01468-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/19/2021] [Indexed: 12/09/2022] Open
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Farshad O, Ommati MM, Yüzügülen J, Jamshidzadeh A, Mousavi K, Ahmadi Z, Azarpira N, Ghaffari H, Najibi A, Shafaghat M, Niknahad H, Heidari R. Carnosine Mitigates Biomarkers of Oxidative Stress, Improves Mitochondrial Function, and Alleviates Histopathological Alterations in the Renal Tissue of Cholestatic Rats. PHARMACEUTICAL SCIENCES 2020. [DOI: 10.34172/ps.2020.60] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Cholestatic liver disease primarily affects hepatic tissue. Cholestasis could also influence the function of other organs rather than the liver. Cholestasis-induced kidney injury is a severe clinical complication known as "cholemic nephropathy" (CN). Bile duct ligation (BDL) is a trustworthy experimental model for inducing CN. Although the precise mechanism of renal injury in cholestasis is not fully recognized, several studies revealed the role of oxidative stress in CN. There is no promising pharmacological intervention against CN. Carnosine (CAR) is a peptide extensively investigated for its pharmacological effects. Radical scavenging and antioxidative stress are major features of CAR. The current study aimed to evaluate the role of CAR supplementation on the CN. Methods: CAR was administered (250 and 500 mg/kg, i.p) to BDL rats for 14 consecutive days. Urine and serum markers of renal injury, biomarkers of oxidative stress in the kidney tissue, and renal histopathological alterations were monitored. Results: Significant elevation in oxidative stress biomarkers, including ROS formation, lipid peroxidation, oxidized glutathione (GSSG) levels, and protein carbonylation were found in the kidney of BDL rats. Moreover, renal tissue antioxidant capacity and reduced glutathione (GSH) levels were significantly decreased in the organ of cholestatic animals. Renal histopathological changes, including tubular atrophy, interstitial inflammation, tissue fibrosis, and cast formation, were detected in the kidney of BDL rats. It was found that CAR administration significantly protected the kidney of cholestatic animals. Conclusion: The antioxidative properties of this peptide might play a fundamental role in its protective properties during cholestasis.
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Affiliation(s)
- Omid Farshad
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz Iran
| | - Mohammad Mehdi Ommati
- College of Life Sciences, Shanxi Agricultural University, Taigu, Shanxi 030801, Peoples’ Republic of China
| | - Jale Yüzügülen
- Eastern Mediterranean University, Faculty of Pharmacy, Famagusta, North Cyprus, Turkey
| | - Akram Jamshidzadeh
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz Iran
- Department of Pharmacology and Toxicology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khadijeh Mousavi
- Department of Pharmacology and Toxicology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Ahmadi
- Eastern Mediterranean University, Faculty of Pharmacy, Famagusta, North Cyprus, Turkey
| | - Negar Azarpira
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hasti Ghaffari
- Department of Veterinary Sciences, Islamic Azad University, Urmia Branch, Urmia, Iran
| | - Asma Najibi
- Department of Pharmacology and Toxicology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzieh Shafaghat
- Department of Pharmacology and Toxicology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Niknahad
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz Iran
- Department of Pharmacology and Toxicology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Heidari
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz Iran
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Pavlidis ET, Pavlidis TE. Pathophysiological consequences of obstructive jaundice and perioperative management. Hepatobiliary Pancreat Dis Int 2018; 17:17-21. [PMID: 29428098 DOI: 10.1016/j.hbpd.2018.01.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/25/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Obstructive jaundice is a common problem in daily clinical practice. Understanding completely the pathophysiological changes in obstructive jaundice remains a challenge for planning current and future management. DATA SOURCES A PubMed was searched for relevant articles published up to August 2016. The effect of obstructive jaundice on proinflammatory cytokines, coagulation status, hemodynamics and organ functions were evaluated. RESULTS The effects of obstructive jaundice included biliary tree, the hepatic cell and liver function as well as systemic complications. The lack of bile in the gut, the disruption of the intestinal mucosal barrier, the increased absorption of endotoxin and the subsequent endotoxemia cause proinflammatory cytokine production (TNF-α, IL-6). Bilirubin induces systemic inflammatory response syndrome which may lead to multiple organ dysfunction syndrome. The principal clinical manifestations include hemodynamic instability and acute renal failure, cardiovascular suppression, immune compromise, coagulation disorders, nutritional impairment, and wound healing defect. The proper management includes full replacement of water and electrolyte deficiency, prophylactic antibiotics, lactulose, vitamin K and fresh frozen plasma, albumin and dopamine. The preoperative biliary drainage has not been indicated in overall, but only in a few selected cases. CONCLUSION The perioperative management is an essential measure in improving the outcome after the appropriate surgical operation in jaundiced patients especially those with malignancy.
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Affiliation(s)
- Efstathios T Pavlidis
- Aristotle University of Thessaloniki, Medical School, Second Surgical Propedeutic Department, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
| | - Theodoros E Pavlidis
- Aristotle University of Thessaloniki, Medical School, Second Surgical Propedeutic Department, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece.
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Martínez-Cecilia D, Reyes-Díaz M, Ruiz-Rabelo J, Gomez-Alvarez M, Villanueva CM, Álamo J, Muntané J, Padillo FJ. Oxidative stress influence on renal dysfunction in patients with obstructive jaundice: A case and control prospective study. Redox Biol 2015; 8:160-4. [PMID: 26774750 PMCID: PMC4731952 DOI: 10.1016/j.redox.2015.12.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 12/20/2022] Open
Abstract
Background: Obstructive Jaundice (OJ) is associated with a significant risk of developing acute renal failure (ARF). The involvement of oxidative stress in the development of cholestasis has been demonstrated in different experimental models. However, its role in the morbidity of human cholestasis is far to be elucidated. The aim of the study was the evaluation of oxidative stress markers in blood from patients with OJ and its relation to complications and benign/malignant evolution of cholestasis. Methods: A prospective cross-sectional study of 105 patients with OJ and 34 control subjects were included. Several markers of liver function and oxidative stress, such as lipoperoxides (LPO), as well as reduced glutathione (GSH), catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities were assessed. Results: The patients with OJ showed a marked increase in plasma levels of LPO, SOD and GSH, while GSH-Px levels were decreased. The increase in lipid peroxidation products and the depletion of SOD activity in blood were also related to renal dysfunction. The highest level of LPO was associated with malignant etiology of the disease. The logistic regression analysis showed that the age of the patient and the levels of LPO in blood were predictors of renal dysfunction in OJ patients. Conclusions: This study demonstrates a correlation between oxidative stress and renal dysfunction patients with OJ. Obstructive jaundice was associated to a decreased glomerular filtration rate. Renal impairment was more frequent in jaundiced patients than in healthy subjects. LPO levels were higher in jaundiced patients than in healhy subjects, with highest levels related to malignant ethiology. Renal function was affected by the intensity of the biliary obstruction, and the balance between LPO and antioxidant defenses
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Affiliation(s)
- David Martínez-Cecilia
- General and Digestive Surgery Service, Complejo Hospitalario de Toledo, Av de Barber, 30, 45071 Toledo, Spain.
| | - María Reyes-Díaz
- Department of General Surgery, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Juan Ruiz-Rabelo
- General and Digestive Surgery Service, Hospital Universitario Reina Sofía, Cordoba, Spain
| | - Manuel Gomez-Alvarez
- General and Digestive Surgery Service, Hospital Universitario Reina Sofía, Cordoba, Spain
| | | | - José Álamo
- Department of General Surgery, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Jordi Muntané
- Department of General Surgery, Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Francisco Javier Padillo
- Department of General Surgery, Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla, Sevilla, Spain
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Costa ELDO, Azevedo GMD, Petroianu A. Morphological changes in the liver and kidneys of rats subjected to terminal ileum exclusion during obstructive cholestasis. Acta Cir Bras 2014; 29:353-8. [PMID: 24919042 DOI: 10.1590/s0102-86502014000600001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 04/22/2014] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To investigate the effects of ileal exclusion on hepatic and renal morphology in extra-hepatic cholestasis. METHODS Twenty four rats were distributed into three groups. Group 1 (control) underwent laparotomy and laparorrhaphy. The animals in groups 2 and 3 underwent hepatic duct ligature and kept in cholestasis for four weeks. After this period, the rats in groups 2 and 3 underwent internal biliary derivation. In Group 3, the last ten centimeters of the terminal ileum were by passed and excluded. Four weeks later, histological and biochemical analysis were performed in all animals of the three groups. RESULTS In Group 1, no abnormalities regarding hepatic morphology were observed. All animals from groups 2 and 3 presented hepatic fibrosis. No difference was observed between the two groups. No morphological differences in renal histology could be identified among the three groups. There were differences in AST (p<0.05), ALT (p<0.05), direct bilirubin (p<0.05), ƔGT (p<0.05), urea (p<0.05) and creatinine (p<0.05) in Group 3 compared to control. CONCLUSION The distal ileum exclusion had no influence upon the hepatic and renal morphological alterations, and biochemical liver and kidney tests have worsened.
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Affiliation(s)
| | | | - Andy Petroianu
- Department of Surgery, Faculty of Medicine, UFMG, Belo Horizonte, MG, Brazil
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Costa ELDO, Petroianu A, Azevedo Júnior GMD. Influence of distal ileum exclusion on hepatic and renal functions in presence of extrahepatic cholestasis. Rev Col Bras Cir 2014; 41:112-6. [PMID: 24918724 DOI: 10.1590/s0100-69912014000200007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 02/20/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To verify whether the ileal exclusion interferes with liver and kidney functional changes secondary to extrahepatic cholestasis. METHODS We studied 24 rats, divided into three groups with eight individuals each: Group 1 (control), Group 2 (ligation of the hepatic duct combined with internal biliary drainage), and Group 3 (bile duct ligation combined with internal biliary drainage and exclusion of the terminal ileum). Animals in Group 1 (control) underwent sham laparotomy. The animals of groups 2 and 3 underwent ligation and section of the hepatic duct and were kept in cholestasis for four weeks. Next, they underwent an internal biliary bypass. In Group 3, besides the biliary-enteric bypass, we associated the exclusion of the last ten centimeters of the terminal ileum and carried out an ileocolic anastomosis. After four weeks of monitoring, blood was collected from all animals of the three groups for liver and kidney biochemical evaluation (albumin, ALT, AST, direct and indirect bilirubin, alkaline phosphatase, cGT, creatinine and urea). RESULTS there were increased values of ALT, AST, direct bilirubin, cGT, creatinine and urea in rats from Group 3 (p < 0.05). CONCLUSION ileal exclusion worsened liver and kidney functions in the murine model of extrahepatic cholestasis, being disadvantageous as therapeutic procedure for cholestatic disorders.
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Abstract
High bilirubin levels are nephrotoxic. Bilirubin can cause a functional proximal tubulopathy or may precipitate into casts associated with acute tubular injury. This condition is known as bile cast nephropathy. The kidney injury is generally reversible if bilirubin levels are decreased early. We present a case wherein an alcoholic patient presented with high bilirubin levels and anuric acute kidney injury. The initial urine analysis suggested intrinsic renal disease. A kidney biopsy, performed a few days after the initiation of dialysis, demonstrated the presence of bile casts along with acute tubular injury. The patient however continued to be dialysis dependent inspite of initiating prednisolone to treat acute alcoholic hepatitis.
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Affiliation(s)
- Adrian Sequeira
- Division of Nephrology and Hypertension, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
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Hatipoglu S, Yildiz H, Bulbuloglu E, Coskuner I, Kurutas EB, Hatipoglu F, Ciralik H, Berhuni MS. Protective effects of intravenous anesthetics on kidney tissue in obstructive jaundice. World J Gastroenterol 2014; 20:3320-3326. [PMID: 24695809 PMCID: PMC3964402 DOI: 10.3748/wjg.v20.i12.3320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/02/2014] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the protective effects on kidney tissue of frequently used intravenous anesthetics (ketamine, propofol, thiopental, and fentanyl) in rats with obstructive jaundice.
METHODS: There is an increased incidence of postoperative acute renal failure in patients with obstructive jaundice. Thirty-two Wistar-albino rats were randomly divided into four equal groups. Laparatomy was performed on each animal in the four groups and common bile ducts were ligated and severed on day 0. After 7 d, laparotomy was again performed using ketamine, propofol, thiopental, or fentanyl anesthesia whose antioxidative properties are well known in oxidative stress in a rat liver model of obstructive jaundice. After 2 h, the rats were sacrificed. Renal tissue specimens were analyzed for catalase, superoxide dismutase and malondialdehyde enzymes activities. All values are expressed as the mean ± SD. P values less than 0.05 were considered statistically significant.
RESULTS: All animals survived without complications until the end of the study. Enlargement in the bile duct and obstructive jaundice were observed in all rats. Catalase was found to be significantly lower in the fentanyl group than in the ketamine (P = 0.039), propofol (P = 0.012), and thiopental (P = 0.001) groups. Superoxide dismutase activities were similar in all groups (P > 0.05). Malondialdehyde was found to be significantly lower in the ketamine group than in the propofol (P = 0.028), thiopental (P = 0.002) and fentanyl (P = 0.005) groups. Malondialdehyde was also lower in the fentanyl group than in the thiopental group (P = 0.001). The results showed that obstructive jaundice sensitizes renal tissue to damage under the different anesthetics.
CONCLUSION: Among the agents tested, ketamine and propofol generated the least amount of oxidative stres on renal tissues in this rat model of obstructive jaundice created by common bile duct ligation. The importance of free radical injury in renal tissue in obstructive jaundice under different intravenous anesthetics during hepatobiliary and liver transplant surgery should be considered for prevention of postoperative acute renal failure.
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Quantifying Serum Level of Glycochenodeoxycholic Acid Using High Performance Liquid Chromatography in Obstructive Jaundice Patients. ISRN HEPATOLOGY 2013; 2013:508368. [PMID: 27335820 PMCID: PMC4890890 DOI: 10.1155/2013/508368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 07/25/2012] [Indexed: 12/02/2022]
Abstract
Introduction. Accumulation of glycochenodeoxycholic acid (GCDC) in serum has a clinical significance as an inductor of pathological hepatocyte apoptosis, which impairs liver function. Inhibition of GCDC accumulation can be used as a marker in therapy. This study was aimed to quantify the serum level of GCDC in obstructive jaundice patients. Methodology. GCDC acid level in the serum was quantified using high performance liquid chromatography (HPLC) technique according to Muraca and Ghoos modified method. It was performed before and after decompression at day 7 and day 14. The sample was extracted with solid phase extraction (SPE) technique on SPE column. The results were analyzed using SPSS V 16.0 (P < 0.05) and quantified with standard curve on GCDC acid. Result. There were 21 cases with range of GCDC acid serum level before decompression was 90.9
(SD 205.5) μmol/L and day 7 after decompression decreased to 4.0 (SD 46.4) μmol/L and then increased to 11.3 (SD 21.9) μmol/L (P < 0.05). This method could separate GCDC acid on serum with good resolution, high precision and accuracy, and linear calibration curve on measured level range. Conclusion. HPLC can quantify GCDC acid serum on obstructive jaundice patients and can be used to support its pharmacokinetic study.
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Jäger B, Drolz A, Michl B, Schellongowski P, Bojic A, Nikfardjam M, Zauner C, Heinz G, Trauner M, Fuhrmann V. Jaundice increases the rate of complications and one-year mortality in patients with hypoxic hepatitis. Hepatology 2012; 56:2297-304. [PMID: 22706920 DOI: 10.1002/hep.25896] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 05/28/2012] [Indexed: 12/13/2022]
Abstract
UNLABELLED Hypoxic hepatitis (HH) is the most frequent cause of acute liver injury in critically ill patients. No clinical data exist about new onset of jaundice in patients with HH. This study aimed to evaluate the incidence and clinical effect of jaundice in critically ill patients with HH. Two hundred and six consecutive patients with HH were screened for the development of jaundice during the course of HH. Individuals with preexisting jaundice or liver cirrhosis at the time of admission (n = 31) were excluded from analysis. Jaundice was diagnosed in patients with plasma total bilirubin levels >3 mg/dL. One-year-survival, infections, and cardiopulmonary, gastrointestinal (GI), renal, and hepatic complications were prospectively documented. New onset of jaundice occurred in 63 of 175 patients with HH (36%). In patients who survived the acute event of HH, median duration of jaundice was 6 days (interquartile range, 3-8). Patients who developed jaundice (group 1) needed vasopressor treatment (P < 0.05), renal replacement therapy (P < 0.05), and mechanical ventilation (P < 0.05) more often and had a higher maximal administered dose of norepinephrine (P < 0.05), compared to patients without jaundice (group 2). One-year survival rate was significantly lower in group 1, compared to group 2 (8% versus 25%, respectively; P < 0.05). Occurrence of jaundice was associated with an increased frequency of complications during follow-up (54% in group 1 versus 35% in group 2; P < 0.05). In particular, infections as well as renal and GI complications occurred more frequently in group 1 during follow-up. CONCLUSION Jaundice is a common finding during the course of HH. It leads to an increased rate of complications and worse outcome in patients with HH.
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Affiliation(s)
- Bernhard Jäger
- Intensive Care Unit 13h1, Department of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria
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Ozturk H, Terzi A, Ozturk H, Kukner A. Effect of sirolimus on renal injury induced by bile duct ligation in rats. Acta Cir Bras 2011; 25:401-6. [PMID: 20877949 DOI: 10.1590/s0102-86502010000500004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 05/25/2010] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To evaluate the effects of sirolimus (SRL) on renal injury in rats with bile duct ligation. METHODS A total of 21 male Sprague-Dawley rats weighing 220-260 g were used. Group 1 (Sham-control, n=7) rats were undergone laparotomy alone and bile duct was just dissected from the surrounding tissue. Group 2 rats (BDL/Untreated, n=7) were subjected to bile duct ligation and no drug was applied. Group 3 rats (BDL/SRL, n =7) received a daily dose of sirolimus (0.5 mg·day(-1) x kg(-1) dissolved 1 ml in saline) by orogastric tube for 14 days after BDL. At the end of the two-week period, biochemical and histological evaluation were processed. RESULTS AST, ALT, AP and TB levels values were decreased in group 3 when compared to group 2. There was no significant difference in serum levels of BUN and creatinine among all the experimental groups. Histological evaluation of the liver of BDL/Untreated group rats demonstrated marked portal fibrosis and signs of major bile duct obstruction with prominent portal and lobular inflammation. In BDL/SRL group, moderate damage was seen. Tubular injury scores were higher in the BDL subgroups; however, group 3 rats showed considerably fewer lesions in the tubules and interstitium compared to the group 2 rats. In group 2 animals, in the epithelial cells of proximal tubules presented vacuoles and hydropic changes, atrophy and inflammatory cell infiltrate in the medullar interstitium. CONCLUSIONS Sirolimus decreased tubulointerstitial lesions in kidney induced by bile duct ligation in rats. The improve effects of sirolimus on renal morphology can be due to improved liver function or due to direct action on the kidney.
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Affiliation(s)
- Hulya Ozturk
- Department of Pediatric Surgery, Medical School, Duzce University, Duzce, Turkey
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Abstract
Many liver diseases coexist with chronic renal disease, because many systemic conditions affect both the liver and the kidneys. Certain liver diseases are also common in patients with chronic renal disease, especially viral hepatitis, either because the renal disease occurs as a complication of viral hepatitis, or the viral hepatitis is acquired as a result of dialysis. Renal tubular dysfunction is also frequently observed with cholestasis. However, liver complications of renal diseases are extremely uncommon, notable examples include nephrogenic ascites and nephrogenic hepatic dysfunction. Nephrogenic ascites can mimic liver cirrhosis with ascites, and it improves with renal transplantation. Nephrogenic hepatic dysfunction is a manifestation of renal cell carcinoma, which settles with the removal of the renal cell carcinoma, but returns with the recurrence of the tumor. In general, the presence of liver disease in patients with chronic renal disease makes management of both conditions more challenging. Viral hepatitis should be treated, if possible, before renal transplant. If cirrhosis is present, renal transplant alone is contraindicated; combined liver and kidney transplantation is indicated in patients with end-stage renal disease and advanced cirrhosis.
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Affiliation(s)
- Florence Wong
- Department of Medicine, Toronto General Hospital, University of Toronto, 9th floor, North Wing, Room 983, 200 Elizabeth Street, Toronto M5G 2C4, Ontario, Canada.
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Deroee AF, Nezami BG, Mehr SE, Hosseini R, Salmasi AH, Talab SS, Jahanzad I, Dehpour AR. Cholestasis induced nephrotoxicity: The role of endogenous opioids. Life Sci 2010; 86:488-92. [DOI: 10.1016/j.lfs.2010.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 02/02/2010] [Accepted: 02/02/2010] [Indexed: 01/24/2023]
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Kwon JA, Lee JE, Huh W, Peck KR, Kim YG, Kim DJ, Oh HY. Predictors of acute kidney injury associated with intravenous colistin treatment. Int J Antimicrob Agents 2010; 35:473-7. [PMID: 20089383 DOI: 10.1016/j.ijantimicag.2009.12.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Revised: 12/01/2009] [Accepted: 12/01/2009] [Indexed: 12/13/2022]
Abstract
Colistimethate sodium (CMS) was recently re-introduced into clinical practice as a last resort for the treatment of nosocomial infections caused by multiresistant bacteria. This retrospective cohort study was designed to identify predictors of acute kidney injury (AKI) associated with intravenous (i.v.) CMS treatment. From March 2007 to July 2008, 71 adult patients receiving CMS for > or = 72h were enrolled. AKI was defined using Risk, Injury, Failure, Loss and End-stage kidney disease (RIFLE) criteria according to serum creatinine. The median total dose of CMS was 54.3mg/kg (range 27.5-94.5mg/kg). AKI developed in 38 patients (53.5%). Cox regression analysis based of cumulative CMS dose (mg/kg) identified four independent predictors of AKI: male sex [hazard ratio (HR)=3.55, 95% confidence interval (CI), 1.47-8.55]; concomitant use of a calcineurin inhibitor (HR=6.74, 95% CI 2.49-18.24); hypoalbuminaemia (serum albumin level <2.0g/dL) (HR=6.29, 95% CI 2.04-19.39); and hyperbilirubinaemia (total bilirubin level >5mg/dL) (HR=3.53, 95% CI 1.17-10.71). In conclusion, AKI was a common complication of i.v. CMS treatment. Male sex, concomitant use of calcineurin inhibitors, hypoalbuminaemia and hyperbilirubinaemia were independent predictors of AKI. The effect of AKI on patient outcomes was not determined.
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Affiliation(s)
- Jeong-Ah Kwon
- Division of Nephrology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea
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Büyükbayram H, Oztürk H, Kara IH, Arslan A. Does the Analysis Based on a Histological and Immunohistochemical Grading System in the Model of BDL Kidney Allow the Quantification of the Degree of Injury? Ren Fail 2009; 26:487-95. [PMID: 15526906 DOI: 10.1081/jdi-200031727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The aim of this study is to evaluate histopathological findings induced by Nomega-nitro-L-arginine methyl ester (L-NAME) and molsidomine (MOL) on the kidney of bile duct ligated rats. Forty Sprague-Dawley rats, each weighing 125 to 140 g, were included in the study. Extent of histological glomerular injury scores (GIS), arterial injury scores (AIS), and tubulointerstitial injury scores (TIS) in each animal were graded. Alpha-smooth muscle actin (alpha-SMA), tenascin, lectin (Ulex europaeus agglutinin-1), and vimentin were used to determine extent of the injury. The cholestasis was evidenced by a significant increase in the levels of serum total bilirubin in BDL rats (p < 0.01). Malondialdeyde MDA levels increased by the bile duct ligation (BDL) to 12.10 +/- 0.45. This value was significantly higher than the other groups (p < 0.01). Changes in the BDL kidney were marked at 7 days after surgery. GIS were observed to have the highest score, especially at juxtamedullary region in BDL/L-NAME rats, and AIS were also the highest score in this region. These observations were lower in BDL/MOL rats. There is a correlation between GIS and AIS scores (r = .2, p < .01). TIS revealed that BDL/L-NAME rats were significantly more damage than rats in the other groups (p<.001). MOL-treated rats showed considerably fewer lesions in the tubules and interstitium (p < .001). The tubular injuries observed in BDL and BDL/L-NAME rats were significantly attenuated by MOL treatment. Lectin was more and extensively stained in tubular epithelia of the BDL/L-NAME group than in the other (p <.05). Expression of tenascin in tubular epithelia was significantly higher in BDL and BDL/L-NAME as compared with controls (p < .01). Fibrous tissue was only observed in the BDL and BDL/L-NAME group. These areas were weakly stained with vimentin. alpha-SMA staining was more reduced in the L-NAME-treated arterioles than in BDL/MOL (p < .05). In conclusion, the analysis of cell injury based on a histological grading system in the model of BDL kidney allows the quantification of the degree of injury.
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Affiliation(s)
- Hüiseyin Büyükbayram
- Faculty of Medicine, Department of Pathology, Dicle University, Diyarbakir, Turkey.
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Abstract
AIM Multiorgan dysfunction is often encountered in jaundiced patients and may compromise the postoperative outcome after liver resection for cholangiocarcinoma (CCA). The aim of the present study was to elucidate evidence-based medicine regarding the benefit of the available preoperative treatments currently used for the preparation of patients before surgery for hilar CCA. MATERIAL AND METHODS An electronic search using the Medline database was performed to identify relevant articles relating to renal dysfunction, bacterial translocation, hemostasis impairment, malnutrition, liver failure, and postoperative outcome in jaundiced patients undergoing liver resection for CCA. RESULTS There is grade B evidence to expand the extracellular water volume and to administer oral synbiotic supplements. Intravenous vitamin K administration is an effective treatment. Perioperative nutritional support should be administered preferably by the enteral route in severely malnourished patients with compromised liver function undergoing extended liver resection (grade A evidence). There is only grade C evidence to recommend a portal vein embolization in patients with CCA when the future remnant liver volume is <40%. CONCLUSIONS A simplified scheme that might be useful in the management of patients presenting with obstructive jaundice was presented. Despite surgical technique improvements, preparation of patients for surgery will continue to be one of the major determinants for the postoperative prognosis of jaundiced patients.
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Affiliation(s)
- E. Oussoultzoglou
- Centre de Chirurgie Viscérale et de Transplantation – Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Université Louis PasteurStrasbourgFrance
| | - D. Jaeck
- Centre de Chirurgie Viscérale et de Transplantation – Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Université Louis PasteurStrasbourgFrance
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Li YF, Liu JG. Change of renal aquaporin 3 expression in rats after release of obstructive jaundice and its significance. Shijie Huaren Xiaohua Zazhi 2008; 16:517-521. [DOI: 10.11569/wcjd.v16.i5.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the change of renal aquaporin 3 (AQP3) expression in rats after release of obstructive jaundice in biliary tract and its significance.
METHODS: Fifty Wistar rats were divided into control group (n = 10) and experimental group (n = 40). A model of experimental obstructive jaundice was established. Seven days after release of obstructive jaundice, serum biochemical parameters were detected. Rats in the experimental group were randomly divided into five subgroups: OJ 0 h, OJ 24 h, OJ 72 h, OJ 1 wk and non-operated control (NC). Biochemical parameters in venous blood were detected and the expression level of renal AQP3 was determined by Western blot.
RESULTS: The TBIL and ALT gradually decreased after release of obstructive jaundice in biliary tract (TBIL: 93.26 ± 1.32 vs 63.31 ± 1.85, 30.78 ± 1.40, 5.04 ± 0.24, P < 0.05; ALT: 70.95 ± 1.22 vs 69.96 ± 0.82, 30.74 ± 1.52, 11.84 ± 1.12, P < 0.05). There was no significant difference in levels of BUN and Cr between the OJ 0 h and NC subgroups, but the expression level of AQP3 was lower in the OJ 0 h subgroup than in the NC subgroup. Both BUN and Cr were significantly decreased 24 h after operation and the expression of AQP3 was further decreased. The levels of BUN and Cr did not markedly change between the OJ 24 h and OJ 72 h subgroups. The expression level of AQP3 was slightly higher, but still lower in the OJ 24 h subgroup than in the NC subgroup (P < 0.05). The expression levels of BUN, Cr and AQP3 were not significantly different between the two groups 7 days after operation.
CONCLUSION: The renal function is further damaged after release of obstructive jaundice in biliary tract. The expression level of AQP3 becomes higher when renal function improves. The sensitivity and specificity of AQP3 are higher than those of BUN and Cr.
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Wang Y, Chen WM, Gao LL, Liu JG. Dopamine modulates perioperative renal medulla aquaporin 2 expression in experimental obstructive jaundice. Shijie Huaren Xiaohua Zazhi 2007; 15:2714-2717. [DOI: 10.11569/wcjd.v15.i25.2714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the changes in aquaporin 2 expression after bile duct recanalization and the effects of low-dose dopamine on perioperative renal aquaporin 2 expression.
METHODS: Seventy wistar rats were randomly allocated to 4 groups. Sixty rats underwent common bile duct ligation, while the other 10 underwent sham operation. The common duct was ligated on a silicon tube of 2 mm external diameter. Seven days later, the experimental rats were randomly allocated into another 3 groups. Rats in the obstructive jaundice group were injected with 9 g/L normal saline (NS), while those in the other 2 groups were injected with dopamine at 5 or 10 µg/(kg•min), respectively. After 2 h treatment, half in each group were killed and the others were killed 24 h later. Serum was collected from each rat to assess hepatic and renal functions. The right renal medulla was separated and kept at -80℃ until used to measure aquaporin 2 expressions by Western blotting.
RESULTS: In the early period of bile duct recanalization, serum bilirubin levels decreased. There were no significant changes in blood urine or creatine. Renal aquaporin 2 expression was detected by Western blotting. Aquaporin 2 expression in the experimental group treated with dopamine 5 µg/(kg•min) was nearly the same as that in the normal group, both at 0 and 24 h (16 010 ± 646 and 22 715 ± 575 vs 21 966 ± 1544 and 21 917 ± 2661), and better than the group treated with dopamine 10 µg/(kg•min).
CONCLUSION: Low-dose dopamine injection appears to modulate expression of aquaporin 2 in the renal collective tubule epithelium, and to have a positive effect on perioperative renal function in obstructive jaundice.
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Clugston A, Paterson HM, Yuill K, Garden OJ, Parks RW. Nutritional risk index predicts a high-risk population in patients with obstructive jaundice. Clin Nutr 2006; 25:949-54. [PMID: 16675070 DOI: 10.1016/j.clnu.2006.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2005] [Revised: 02/24/2006] [Accepted: 03/02/2006] [Indexed: 12/01/2022]
Abstract
BACKGROUND Malnutrition is common in obstructive jaundice but is difficult to define. The aim of this study was to compare definitions of malnutrition in patients with obstructive jaundice to identify correlation with mortality, complications and length of hospital stay after intervention. METHODS Prospective case-control study comparing 39 inpatients with obstructive jaundice with 21 controls. Body mass index (BMI), skin-fold thickness (TSF), mid-arm muscle circumference (MAMC), percentage weight loss, nutritional risk index (NRI) and malnutrition universal screening tool (MUST) were measured and compared. Duration of admission, interventions, complications and outcome were recorded prospectively. RESULTS Patients with obstructive jaundice were significantly malnourished compared to controls. Severe malnutrition was equally prevalent in benign and malignant disease. Malnourished patients had higher mortality and longer duration of stay after intervention compared to non-malnourished patients. NRI<83.5 was significantly associated with mortality and longer duration of hospital admission but not complication rate. CONCLUSION NRI is simple to use and defines a high-risk sub-group of patients with obstructive jaundice.
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Affiliation(s)
- April Clugston
- Clinical and Surgical Sciences (Surgery), Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, UK
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Abstract
The majority of patients with periampullary malignancies currently undergo biliary drainage before pancreaticoduodenectomy. Placement of an endoprosthesis reliably ameliorates jaundice and pruritus. However, preoperative biliary drainage leads to bile colonization and increases the risk of postoperative wound infection after pancreatic resection. Preoperative biliary drainage does not appear to lower postoperative morbidity or mortality following pancreatic resection and does not lower but probably increases costs associated with pancreatic resection. Preoperative biliary drainage is frequently used with little clinical benefit and its utilization should be limited to specific clinical indications, i.e. patients receiving neoadjuvant therapy, patients waiting several weeks or more for surgical evaluation and resection, patients with cholangitis.
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Affiliation(s)
- Rurik C. Johnson
- Department of Surgery, University of Pittsburgh Medical SchoolPittsburgh PAUSA
| | - Steven A. Ahrendt
- Department of Surgery, University of Pittsburgh Medical SchoolPittsburgh PAUSA
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Padillo FJ, Cruz A, Briceño J, Martin-Malo A, Pera-Madrazo C, Sitges-Serra A. Multivariate analysis of factors associated with renal dysfunction in patients with obstructive jaundice. Br J Surg 2005; 92:1388-92. [PMID: 16078295 DOI: 10.1002/bjs.5091] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The aim was to evaluate the factors determining preoperative renal dysfunction in patients with obstructive jaundice. METHODS In a prospective cross-sectional observational study, 63 patients, 27 with benign and 36 with malignant obstructive jaundice, were investigated at admission and compared with 25 healthy control subjects. Variables analysed included extracellular body water (ECW) compartment, plasma levels of aldosterone, renin, atrial natriuretic peptide, vasopressin, nitric oxide, endothelin (ET) 1 and prostaglandin E2 (PGE2), urinary nitric oxide and PGE2, serum albumin and renal function. RESULTS The metabolic profile of obstructive jaundice was characterized by a depletion of the ECW (P = 0.004), and increased plasma levels of atrial natriuretic peptide (P < 0.001), ET-1 (P = 0.044), vasopressin (P = 0.017), aldosterone (P = 0.005) and renin (P = 0.001). Increased plasma (P < 0.001) and urinary (P = 0.001) PGE2 levels were also found. Fifty-four per cent of patients had a creatinine clearance of less than 70 ml/min. In multivariate analysis, serum bilirubin, renin, ET-1, PGE2, decreased urinary sodium excretion and age were identified as predictors of renal dysfunction. CONCLUSIONS Renal dysfunction in patients with obstructive jaundice was associated with the degree of biliary obstruction, age of the patient and reduced urinary sodium excretion. These alterations were closely related to derangements in sodium- and water-regulating hormones.
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Affiliation(s)
- F J Padillo
- Department of Surgery, Hospital Reina Sofía, Córdoba, Barcelona, Spain
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Padillo FJ, Briceño J, Cruz A, Chicano M, Naranjo A, Vallejo J, Martín-Malo A, Pera-Madrazo C, Sitges-Serra A. Randomized clinical trial of the effect of intravenous fluid administration on hormonal and renal dysfunction in patients with obstructive jaundice undergoing endoscopic drainage. Br J Surg 2005; 92:39-43. [PMID: 15521079 DOI: 10.1002/bjs.4790] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Renal dysfunction in patients with biliary obstruction is associated with extracellular water depletion. This study examined the effect of preoperative saline infusion before biliary drainage on hormonal and renal functional derangements in patients with obstructive jaundice. METHODS In a randomized study, 49 patients with malignant obstructive jaundice were investigated at baseline, on the day of drainage, and at 24 h, 72 h and 7 days after internal endoscopic biliary drainage. Patients were randomized to receive (n = 22) or not to receive (n = 27) 3000 ml normal saline intravenously for 24 h before drainage. Variables analysed included extracellular water volume, creatinine clearance, and serum levels of aldosterone, renin, atrial natriuretic peptide (ANP), vasopressin and albumin. RESULTS Preoperative saline infusion produced a rise in creatinine clearance, diuresis, ANP concentration and extracellular water volume but this did not translate into better recovery of renal function after operation. Drainage produced a fall in creatinine clearance in all patients, but hormonal and renal function had recovered by 2 days after restoration of bile flow, independently of preoperative hydration. CONCLUSION Fluid administration expands the extracellular water compartment before drainage but fails to improve renal function after drainage. Definitive improvement in endocrine and renal function requires the restoration of bile flow into the duodenum.
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Affiliation(s)
- F J Padillo
- Department of Surgery, Hospital Universitari del Mar, Barcelona, Spain
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Parks RW, Halliday MI, McCrory DC, Erwin P, Smye M, Diamond T, Rowlands BJ. Host immune responses and intestinal permeability in patients with jaundice. Br J Surg 2003; 90:239-45. [PMID: 12555304 DOI: 10.1002/bjs.4029] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Systemic endotoxaemia is implicated in the development of complications associated with obstructive jaundice. The aims of these studies were to assess the systemic immune response to intervention in patients with jaundice and to compare the effects of surgical and non-surgical biliary drainage on host immune function and gut barrier function. METHODS In the first study, 18 jaundiced and 12 control patients were studied to assess systemic immune responses before and after intervention. In the second study, immune responses and gut barrier function were assessed following surgical and non-operative biliary decompression in 45 patients with jaundice. RESULTS Endotoxin antibody concentrations fell significantly in patients with jaundice immediately after surgical intervention, but not after non-operative biliary drainage. This decrease was associated with a significant increase in serum P(55) soluble tumour necrosis factor (sTNF) receptor concentration (5.3 versus 10.5 ng/ml; P < 0.001), urinary excretion of P(55) TNF receptors (21.4 versus 78.8 ng/ml; P = 0.002) and intestinal permeability (lactulose : mannitol ratio 0.032 versus 0.082; P = 0.048). Intestinal permeability was significantly increased in patients with jaundice compared with controls (0.033 versus 0.015; P = 0.002). CONCLUSION These data suggest that obstructive jaundice is associated with impaired gut barrier function and activation of host immune function that is exacerbated by intervention. Surgery causes an exaggerated pathophysiological disturbance not seen with non-operative biliary drainage procedures.
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Affiliation(s)
- R W Parks
- Department of Surgery, Queen's University of Belfast, Northern Ireland, UK.
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Abstract
Management of the surgical patient with liver disease begins with a careful preoperative assessment (Fig. 1). Any clues to liver disease on history and physical examination should be investigated to ascertain the cause of the clinical finding. More data on surgical patients with unexpected liver disease are now available. Patients undergoing emergent surgery are at significant risk of developing liver dysfunction. Child's class still correlates strongly to postoperative complications. Cornerstones of perioperative management in these patients are medical treatment of complications of chronic liver disease, such as ascites; coagulopathy; prevention of encephalopathy; and rapid treatment of dangerous postoperative complications, such as acute acalculous cholecystitis. Evolving knowledge of the effects of anesthesia, improving surgical techniques, and use of better diagnostic tests will help in the reduction of perioperative complications in these patients.
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Affiliation(s)
- Mohammed K Rizvon
- Medical Consultation Service, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, USA.
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Cruz A, Padillo FJ, Túnez I, Muñoz C, Granados J, Pera-Madrazo C, Montilla P. Melatonin protects against renal oxidative stress after obstructive jaundice in rats. Eur J Pharmacol 2001; 425:135-9. [PMID: 11502279 DOI: 10.1016/s0014-2999(01)01173-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The goals of this study were to analyze the renal oxidative status in experimental biliary obstruction and to evaluate the impact of melatonin on renal oxidative stress. Cholestasis was done by double ligature and section of the extra-hepatic biliary duct. Melatonin was injected i.p. (500 microg/kg/day). Malondialdehyde, reduced glutathione, catalase, superoxide dismutase, glutathione reductase, glutathione peroxidase and glutathione transferase were determined in the renal tissue. After biliary obstruction, an increase in malondialdehyde (P<0.0001) and a fall in reduced glutathione (P<0.0001) were seen. Moreover, the scavenger enzyme activity had significantly diminished. After melatonin administration, the malondialdehyde fell significantly (P<0.0001), whereas reduced glutathione showed an important increase (P<0.0001) compared with the ligated bile duct group. Experimental bile duct obstruction was associated to an increase of renal oxidative stress. Treatment with melatonin decreased the renal lipid peroxidation, and both the reduced glutathione as well as the scavenger enzyme activity recovered.
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Affiliation(s)
- A Cruz
- Department of General Surgery, Reina Sofía University Hospital, Córdoba, Spain
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González J, Sanz L, Azcano E, Navarrete F, Martínez E. Morbimortalidad y supervivencia tras la paliación de la obstrucción maligna de la vía biliar. Cir Esp 2001. [DOI: 10.1016/s0009-739x(01)71785-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Utkan ZN, Utkan T, Sarioglu Y, Gönüllü NN. Effects of experimental obstructive jaundice on contractile responses of dog isolated blood vessels: role of endothelium and duration of bile duct ligation. Clin Exp Pharmacol Physiol 2000; 27:339-44. [PMID: 10831233 DOI: 10.1046/j.1440-1681.2000.03256.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
1. We examined the effects of experimental obstructive jaundice caused by bile duct ligation (BDL) on vascular smooth muscle function, as well as the underlying mechanisms involved, by recording responses to noradrenaline (NA), 5-hydroxytryptamine (5-HT) and acetylcholine (ACh) in canine isolated renal arteries and to NA in isolated mesenteric arteries in vitro. All studies were performed 7 days after the onset of BDL in renal arteries and 3, 7 and 15 days after the onset of BDL in mesenteric arteries. 2. The maximum contraction evoked by both NA and 5-HT was significantly attenuated with no change in agonist potency (pD2 value) in renal arteries with endothelium obtained from 7 day BDL dogs when compared with those from sham-operated controls (SO). However, the reduction almost disappeared when the endothelium was removed. In contrast, no change in the responsiveness of renal arteries to KCl could be detected at 7 day BDL. Endothelium-dependent relaxations produced by ACh were significantly increased in renal artery rings from 7 day BDL dogs, but the endothelium-independent relaxations produced by papaverine in BDL preparations were not changed when compared with SO controls. 3. At 7 and 15 days after BDL, the Emax values of the mesenteric ring of BDL dogs to NA were significantly lower than that of SO controls, whereas 3 days after surgery there was no significant difference. The pD2 values in arteries obtained from 15 day BDL animals were significantly lower than those obtained from SO control animals. However, no significant changes in pD2 values were seen 3 and 7 days after the onset of BDL. 4. In conclusion, it is suggested that enhanced production and/or release of nitric oxide, mainly of endothelial origin, is associated with reduced vascular responses to contractile agents in experimental obstructive jaundice and that this effect is related to the duration of obstructive jaundice. These results may explain, at least in part, a cause of hypotension that leads to renal failure in patients with obstructive jaundice.
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Affiliation(s)
- Z N Utkan
- Department of General Surgery, Faculty of Medicine, Kocaeli University, Derince-Kocaeli, Turkey
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Rodrigo R, Avalos N, Orellana M, Bosco C, Thielemann L. Renal effects of experimental obstructive jaundice: morphological and functional assessment. Arch Med Res 1999; 30:275-85. [PMID: 10573628 DOI: 10.1016/s0188-0128(99)00027-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The pathophysiology of renal impairments occurring in obstructive jaundice has been extensively studied, but the underlying mechanism of these derangements remains unclear. The aim of the present study was to investigate the time-related morphological and functional changes occurring in the kidneys of rats undergoing obstructive jaundice. METHODS Histological examination, renal function assessment and determination of (Na + K)-ATPase activity were performed in the kidneys of rats 7, 14, and 21 days following bile duct ligation (BDL) or sham operation (sham). RESULTS Glomerular filtration rate was unaffected by BDL throughout the period of the study. Tubular effects occurred at days 7 and 14, being more marked at day 7, and consisted of an increase of about twice in the fractional excretion of sodium and chloride, paralleled by a decreased proximal and distal tubular reabsorption of sodium of about 50 and 40%, respectively. Natriuresis was consistent with augmentation of osmolar clearance but it was not associated with changes in the activity of renal (Na+ + K+)-ATPase. The ability to dilute urine was impaired at days 14 and 21 after BDL. Additionally, these effects were accompanied by decreased tubulointerstitial fibrosis and vasodilation of inner medullary capillaries. At day 21, the parameters of tubular function in BDL and sham groups were not significantly different. CONCLUSIONS These data support the view that raised natriuresis taking place in the initial 2 weeks following BDL is due mainly to tubular effects. The contribution of hemodynamic, paracrine and humoral mediators is discussed.
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Affiliation(s)
- R Rodrigo
- Programa de Farmacología Molecular, Facultad de Medicina, Universidad de Chile, Santiago de Chile.
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Affiliation(s)
- L S Friedman
- Gastrointestinal Unit (Medical Services), Massachusetts General Hospital and the Department of Medicine, Harvard Medical School, Boston, MA, USA.
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Wójcicki M, Drozdzik M, Sulikowski T, Gawronska-Szklarz B, Wójcicki J, Rózewicka L, Skowron J, Zielinski S, Musial HD, Zakrzewski J. Pharmacokinetics of intragastrically administered digoxin in rabbits with experimental bile duct obstruction. J Pharm Pharmacol 1997; 49:1082-5. [PMID: 9401942 DOI: 10.1111/j.2042-7158.1997.tb06046.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A change in the functioning of the liver as a result of experimental cholestasis could result in a change in the biotransformation of drugs. The aim of this study was to evaluate the effect of extrahepatic cholestasis on the pharmacokinetics of digoxin. The investigation was performed on male rabbits randomly divided into two groups: sham-operated and animals with bile-duct ligation. Digoxin (0.02 mg kg-1) was administered intragastrically as a single dose. Biomedical and anatomo-pathological tests and pharmacokinetic assays were performed before the operation and on the 6th day after surgery. A significant increase in area under the serum concentration-time curve and in mean residence time, a decrease in total body clearance, a reduction in the volume of distribution and increases in maximum concentration and the time to reach maximum concentration were observed in animals with the bile-duct ligation. These results suggest reduced elimination of digoxin in animals with obstructive cholestasis.
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Affiliation(s)
- M Wójcicki
- Department of Experimental and Clinical Pharmacology, Pomeranian Medical Academy, Szczecin, Poland
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Inan M, Sayek I, Tel BC, Sahin-Erdemli I. Role of endotoxin and nitric oxide in the pathogenesis of renal failure in obstructive jaundice. Br J Surg 1997; 84:943-7. [PMID: 9240131 DOI: 10.1002/bjs.1800840710] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is an increased incidence of postoperative renal failure in patients with obstructive jaundice. The purpose of this study was to investigate the role of endotoxaemia and nitric oxide in this association. METHODS In bile duct-ligated, sham-operated and control rats, plasma total bilirubin levels, creatinine clearance and plasma endotoxin were determined. Endothelium-dependent vasodilatation to acetylcholine, and endothelium-independent vasodilatation to nitroglycerine and forskolin were evaluated in isolated perfused rat kidney. RESULTS Twenty-one of 27 bile-duct ligated rats had endotoxaemia. Plasma bilirubin levels were higher and creatinine clearance was significantly reduced in the bile duct-ligated endotoxin-positive group compared with values in the other groups. Furthermore, in the isolated perfused rat kidney from rats with endotoxaemia, basal perfusion pressure and renal vascular relaxation to acetylcholine and nitroglycerine which is mediated by guanosine cyclic 3',5'-cyclic monophosphate (cGMP) were significantly reduced, but relaxation to forskolin mediated by adenosine cyclic 3',5'-cyclic monophosphate did not change. CONCLUSION Endotoxaemia in obstructive jaundice may induce overproduction of nitric oxide that may lead to impairment of cGMP-associated vasodilatation and disrupt autoregulation of the renal vascular bed. This may contribute to renal failure in obstructive jaundice.
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Affiliation(s)
- M Inan
- Department of General Surgery, School of Medicine, Hacettepe University, Ankara, Turkey
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