title: Renal function after dopamine and fluid administration in patients with malignant obstructive jaundice. A prospective randomized study.
abstract: OBJECTIVE
  Acute renal failure is a relevant complication in obstructive jaundice (OJ). The extracellular water volume (ECW) depletion and myocardial dysfunction affects haemodynamic and renal disturbance in patients with OJ.
  
  
  METHODS
  A prospective open randomised study was conducted to evaluate the effect of peridrainage saline infusion associated with dopamine administration on hormonal and renal function derangements in 102 patients with malignant OJ. Patients were randomly distributed according to whether (n=64) or not (n=38) received dopamine with saline solution before endoscopic biliary drainage. Furthermore, patients receiving dopamine were randomly distributed whether (n=31) or not (n=33) received additional dopamine administration during the postdrainage phase. Different parameters such as ECW, serum levels of aldosterone, renin, atrial natriuretic peptide (ANP), antidiuretic hormone (ADH), endothelin-1 (ET-1), urine PGE2 and creatinine clearance (CrCl) were analyzed.
  
  
  RESULTS
  Fluid administration was accompanied by an increase in the ECW (p=0.01) and an improvement in the CrCl (p=0.01). Dopamine increased CrCl by 11% (p=0.04) and reduced urinary PGE2 concentration (p=0.02). After drainage, a transient worsening of CrCl was seen in patients on i.v. fluid infusion alone but not in dopamine groups (p=0.001). Improvement of CrCl after dopamine administration was found in patients with serum bilirubin > 16 mg/dl and sodium urine excretion <145 mEq/l.
  
  
  CONCLUSIONS
  The administration of dopamine associated with appropriate i.v. fluid infusion in the peridrainage period has an impact on renal function only in selected patients with malignant biliary obstruction. This effect is more relevant in patients with higher marked cholestasis.
authors: Gastroenterology Department, Puerta del Mar University Hospital, Cadiz, Spain.
authors: Antonio
authors: A
authors: Naranjo
authors: Adolfo
authors: A
authors: Cruz
authors: Patricia
authors: P
authors: López
authors: Maite
authors: M
authors: Chicano
authors: Alejandro
authors: A
authors: Martín-Malo
authors: Antonio
authors: A
authors: Sitges-Serra
authors: Jordi
authors: J
authors: Muntané
authors: Javier
authors: J
authors: Padillo
mesh_terms: D058186:Acute Kidney Injury / Q000503:physiopathology*; D000328:Adult; D000368:Aged; D001834:Body Water / Q000378:metabolism; D004322:Drainage; D045604:Extracellular Fluid / Q000187:drug effects; D005260:Female; D006728:Hormones / Q000097:blood; D006801:Humans; D007262:Infusions, Intravenous; D041781:Jaundice, Obstructive / Q000503:physiopathology*; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage*; D013566:Sympathomimetics / Q000008:administration & dosage*
chemical_list: D006728:Hormones; D013566:Sympathomimetics; D012965:Sodium Chloride