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Related Experiment Videos

Bile salts, endotoxin and renal function in obstructive jaundice.

C J Cahill1, J A Pain, M E Bailey

  • 1Department of Surgery, Royal Surrey County Hospital, Guildford Surrey.

Surgery, Gynecology & Obstetrics
|December 1, 1987
PubMed
Summary

Administering sodium deoxycholate before surgery can prevent postoperative acute renal failure in patients with jaundice by eliminating endotoxemia. This bile salt replacement therapy shows promise for improving surgical outcomes.

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Area of Science:

  • Gastroenterology
  • Nephrology
  • Surgical Research

Background:

  • Obstructive jaundice complicates surgical treatment with a nearly 10% incidence of postoperative acute renal failure.
  • Renal failure in jaundiced patients is linked to bacterial endotoxemia, exacerbated by impaired bile salt function and increased intestinal endotoxin absorption.
  • Bile salt replacement therapy is hypothesized to prevent endotoxemia and subsequent renal failure.

Purpose of the Study:

  • To investigate the efficacy of preoperative oral bile salt replacement in preventing postoperative acute renal failure in patients with obstructive jaundice.
  • To assess the impact of sodium deoxycholate and chenodeoxycholic acid on endotoxemia and renal function.

Main Methods:

  • A study involving 46 patients with jaundice undergoing surgical treatment.

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  • Patients were divided into three groups: preoperative sodium deoxycholate (n=12), preoperative chenodeoxycholic acid (n=12), and a control group (n=22).
  • Endotoxemia was measured using the Limulus test, and renal function was assessed via 24-hour creatinine clearance.

    • Main Results:

    • No patients receiving preoperative sodium deoxycholate exhibited systemic endotoxemia or postoperative renal function impairment.
    • The chenodeoxycholic acid group showed a reduction in endotoxemia, but this was not statistically significant, and renal function was not protected.
    • Control patients experienced expected rates of endotoxemia and renal impairment.

    Conclusions:

    • Preoperative administration of sodium deoxycholate effectively prevents endotoxemia and postoperative acute renal failure in jaundiced patients.
    • Chenodeoxycholic acid did not demonstrate significant protective effects on endotoxemia or renal function.
    • Sodium deoxycholate is a promising therapeutic agent warranting further investigation in multicenter trials for managing obstructive jaundice complications.