Cholegraphy-induced acute renal failure: its relation to subsequent surgical therapy

The cases of three patients who developed acute renal failure shortly after receiving oral or intravenous cholegraphic agents are analyzed, and the pertinent literature is reviewed. Two patients required subsequent surgical intervention: one had cholecystectomy and common bile duct exploration; the other had right hemicolectomy and cholecystectomy for coexistent gangrenous cholecystitis and appendicitis. The third patient had chronic active liver disease. In all three, the cholegraphic agents were given while the patients were dehydrated. Two patients required hemodialysis. In all three, renal function returned to normal and was not altered by the subsequent surgical intervention. The cause of this complication remains uncertain but hepatic dysfunction and the combination of uricosuria and dehydration are possible factors. Awareness of its occurrence should result in proper hydration of patients prior to the administration of cholegraphic agents. Surgical intervention, if necessary, can be performed safely, preferably after renal function has returned to normal.