Effect of Chronic Bile Duct Obstruction on Renal Handling of Salt and Water

Abstract

A B S T R A C T Renal sodium reabsorption and the concentrating and diluting abilities of the kidney were evaluated in the same trained mongrel dogs before and after chronic common bile duct ligation (BDL). Glomerular filtration rate (GFR) and CPAH were not altered by BDL. The natriuretic response to a standardized infusion of 0.45% solution of NaCl was markedly blunted by BDL (P < 0.01); calculated distal sodium delivery was significantly less in experiments after BDL than in control studies. Furthermore, the fractional reabsorption of sodium at the diluting segment for any given rate of distal delivery was enhanced by BDL. Similarly, CH2o/ 100 ml GFR for a given sodium delivery was higher after BDL than control values. Maximal urinary concentration (Uosm-max) was lower after BDL, and the mean Uosm-max for the whole group of animals was 60% of the control value (P<0.001). Mean maximal TCH-o/100 ml GFR after BDL was not different from control values; however, TCH2o/100 ml GFR for a given Cosm/100 ml GFR was lower after BDL in three dogs only. The sodium content of the inner part of renal medulla after BDL was significantly lower than the values obtained in control animals. The excretion of an oral water load in the conscious state was impaired after BDL; although all animals excreted hypotonic urine, urinary osmolality was usually higher after BDL than in control studies. Maximal urinary concentration and the excretion of an oral water load were not affected by sham operation.These studies demonstrate that chronic, common bile duct ligation is associated with (a) enhanced sodium Dr.

A micropuncture study of renal salt and water retention in chronic bile duct obstruction.

“…Thus, patients with cirrhosis of the liver may demonstrate enhanced renal reabsorption of sodium, delayed excretion of a water Received for publication 16 October 1974 and in revised form 30 December 1974. load, ascites, edema, and impaired urinary concentrating ability (4)(5)(6)(7)(8). Similar abnormalities were demonstrated in clearance studies in dogs with common bile duct ligation (3). In this latter study, the authors found that glomerular filtration rate (GFR)' and effective renal plasma flow (CPAH) were not altered by chronic bile duct ligation, and that the enhanced reabsorption of sodium occurred in the proximal and diluting segments of the nephron.…”

“…INTRODUCTION Previous studies in dogs have shown that ligation of the common bile duct leads to sodium and water retention by the kidney and ascites formation (1)(2)(3). Although the mechanism of the abnormal renal function was not clear, this animal model was shown to bear several close similarities to human pathophysiology observed in patients with liver disease.…”

Intrarenal mechanisms of salt retention after bile duct ligation in rats.

“…The causes of altered sodium excretion have been examined under a number of experimental conditions that lead to positive sodium balance (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). A great many possible causes of sodium retention have been identified, but a common unifying hypothesis has not yet been advanced.…”

“…In dogs studied by Levy (11) after ligation of the thoracic inferior vena cava, the plasma volume was expanded. He and others have suggested that differences in plasma volume may be one factor responsible for the great variability of proximal tubular function which has been reported in various experimental models associated with sodium retention (1,(7)(8)(9)(10)(11).…”

Dogs with experimental cirrhosis of the liver but without intrahepatic hypertension do not retain sodium or form ascites.

“…All animals had severe disturbance in liver function and were deeply jaundiced. Table I summarizes some important features of all 13 dogs for the control and experimental phases of the study. Progression of the liver disease was associated with marked weight loss, despite normal food intake.…”