Experimental and clinical studies on renal disturbance in obstructive jaundice

Renal functions and the clinical courses of 14 patients with renal disturbances associated with obstructive jaundice were studied. All patients had high concentrations of serum bilirubin, long durations of jaundice and episodes of shock due to massive hemorrhage or severe inflammation. In an experimental study on jaundiced rats, effects of hypotension or bilateral renal artery occlusion on renal function and renal cortical mitochondrial respiration at 1 week, 3 or 6-weeks after biliary obstruction were investigated. In jaundiced rats, there was no remarkable difference in renal function, but the renal mitochondrial respiration indices decreased with prolongation of the biliary obstruction. In hypotensive rats with prolonged biliary obstruction, the mitochondrial function was impaired, and in the rats with renal artery occlusion, the mitochondrial impairment was more severe. Based on these clinical and experimental data, it is tentatively suggested that patients with prolonged jaundice should be considered in a prodromal state of renal failure and that any minute circulatory failure may induce acute renal failure.