Cholangitis With Acute Renal Failure

Abstract

Obstructive cholangitis with acute renal failure is a dramatic syndrome which merits individual definition. Twenty-one patients with acute suppurative cholangitis complicated by rapidly developing renal insufficiency were studied, and the severity of the renal failure, an acute interstitial tubulopathy, bore no significant relationship to the serum bilirubin level. The mechanism of renal damage was clearly related to episodes of septicemia. Increasing experience has modified the approach to treatment. The dominant septic problem can often be controlled by vigorous antibiotic and fluid therapy, allowing time for spontaneous improvements in renal function. All patients thus operated at a distance from the septic episode survived. If emergency operation is required because of persistent or recrudescnet sepsis, the necessity for dialysis should be considered first; the circumstances demanding dialysis are defined. The priorities in therapy are then: 1) treatment of the infection, 2) treatment of the renal failure, and finally 3) operation. The amount of the operation depends on the evolution of the sepsis, but should be preceded by dialysis when required.

Prognosis in Acute Renal Failure Accompanied by Jaundice

“…While various factors have been implicated for the persistent high mortality, the most widely recognized is the role of sepsis [4][5][6]. The incidence of sepsis in patients with acute renal failure is very high and the finding of sterile blood cultures is not always of clinical value because antibiotics are frequently adminis tered in the early course of the disease.…”

Gallstone disease presenting as septicaemic shock

“…Williams and Dawson (1969) recommended that, in order to prevent acute renal failure, it was first necessary to maintain an adequate circulating volume and high flow of dilute urine with adequate transfusion and diuretics, and also to give massive doses of antibiotics. Emergency operation could then be undertaken if there was no improvement in the patient's condition over the next 24-36 h. Bismuth et al (1975) reported on 3 patients with acute renal failure complicating acute suppurative cholangitis who were operated upon as an emergency; all 3 died. In the light of this experience they managed their next 15 patients fist by treating the shock by resuscitation and antibiotics, secondly by performing dialysis and finally by operating when the patient's general condition was, at least to some extent, stabilized; 12 of 15 patients so managed survived.…”

Διαταραχη Της Νεφρικης Λειτουργιας Επι Χειρουργουμενων Δι'αποφρακτικον Ικτερον Με Ενδοτοξιναιμιαν

“…Ή βαρύτητα, εν τούτοις, της νεφρικής ανεπαρκείας σε 25 περιπτώσεις πυώδους χολαγγειΐτιδος δεν είχε σχέση με το ποσό τής χολερυθρίνης. Άπο το σημείο αυτό ξεκινώντας, οι Bismuth et al (1975) καταλήγουν στο συμπέρασμα ότι σε τέ τοιες περιπτώσεις σημασία έχει ό βαθμός τής σηψαιμίας και οχι απλώς τοΰ ίκτερου.…”

“…Στον πίνακα 2 παρουσιάζονται συγκεντρωτικά οί μέσες τι μές καθάρσεως της ενδογενούς κρεατινίνης. Συγκεκριμένα, ή Bismuth et al (1975), οί όποιοι, ένώ δέν δια πίστωσαν αξιόλογη σχέση μεταξύ τοΰ ποσού χολερυθρίνης του ορού καί τής βαρύτητος τής νεφρικής λειτουργίας σε α σθενείς μέ αποφρακτική χολαγγειΐτιδα, έν τούτοις, υπήρξε σα φής συσχέτιση μέ τίς περιπτώσεις εκείνες, πού παρουσίαζαν σηπτική κατάσταση μέ Gram-αρνητικά μικρόβια.…”