Effects of percutaneous transhepatic biliary drainage on renal function in patients with obstructive jaundice.
OBJECTIVE
We assessed the effects of percutaneous transhepatic biliary drainage on renal function in patients with obstructive jaundice using the estimated glomerular filtration rate (eGFR) and evaluated the factors associated with renal dysfunction.


METHODS
Between July 2007 and September 2009, 108 consecutive patients (69 men 39 women; median age, 59 years; range, 29-87 years) with obstructive jaundice (20 benign, 88 malignant) that were unsuitable for endoscopic retrograde cholangiopancreticography were evaluated at admission and at follow-up exams five and thirty days after percutaneous transhepatic biliary drainage. Two patients with suspected contrast-induced nephropathy were excluded. Renal function was assessed by measuring levels of urea, creatinine and electrolytes and evaluating the modification of diet in the renal disease formula for eGFR.


RESULTS
eGFR was < 60 mL/min/1.73 m2 before percutaneous transhepatic biliary drainage in 27 patients (25%) and increased significantly 30 days after percutaneous transhepatic biliary drainage (P = 0.008). In the malignant external drainage subgroup, there was a significant increase in eGFR on the fifth day after percutaneous transhepatic biliary drainage (P = 0.038). The procedure-related mortality rate was zero. Nine malignant patients (8.49%) died within thirty days due to underlying diseases. On the fifth day, eGFR was significantly lower in these patients than in surviving patients (P = 0.049), and bilirubin levels were significantly higher before the intervention than in surviving patients (P = 0.04). Multiple logistic regression analysis showed that serum direct bilirubin is a significant predictor of renal function (P = 0.049).


CONCLUSIONS
Obstructive jaundice is associated with renal dysfunction, and serum direct bilirubin is a significant predictor of renal function. Percutaneous transhepatic biliary drainage improves renal function and is crucial for prognosis of obstructive jaundice.
Parıldar
Zuhal
Z
Department of Clinical Biochemistry, Ege University Faculty of Medicine, İzmir, Turkey. zuhalparildar@ege.edu.tr
Çınar
Celal
C
Barutçuoğlu
Burcu
B
Başol
Güneş
G
Parıldar
Mustafa
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000379:methods*; D015331:Cohort Studies; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D041781:Jaundice, Obstructive / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D007677:Kidney Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome