Multivariate analysis of factors associated with renal dysfunction in patients with obstructive jaundice.
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.
Padillo
F J
FJ
Department of Surgery, Hospital Reina Sofía, Córdoba, Barcelona, Spain.
Cruz
A
A
Briceño
J
J
Martin-Malo
A
A
Pera-Madrazo
C
C
Sitges-Serra
A
A
D009320:Atrial Natriuretic Factor / Q000097:blood; D015232:Dinoprostone / Q000097:blood; D019332:Endothelin-1 / Q000097:blood; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000097:blood / Q000150:complications*; D007674:Kidney Diseases / Q000097:blood / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D014883:Water-Electrolyte Imbalance / Q000209:etiology
D019332:Endothelin-1; D009320:Atrial Natriuretic Factor; D015232:Dinoprostone