Observation of renal function in patients with surgical jaundice

Abstract

The association between surgical jaundice and postoperative acute renal failure (ARF) has been recognized since long. Obstructive (surgical) jaundice is a common entity, and patients undergoing surgery have a constant risk of developing ARF, and this may raise the mortality figures to an alarming level. The present study included 50 patients of obstructive jaundice aged between 10 and 70 years. The patients were evaluated in detail, and data collection was performed using a structured questionnaire. Patients were investigated using routine laboratory investigations of blood, urine, and stool, liver function tests, renal function tests, and radiological investigations. All important tests related to liver function and renal functions were done on the 1st day of admission, 3rd day of admission, 2nd postoperative day, 7th postoperative day, and 14th postoperative day—if renal function derangements were found. According to the diagnostic criteria of the present series 74% of patients showed renal failure on the 2nd postoperative day. In the present series, out of seven, four renal parameters, namely serum creatinine, specific gravity, inulin clearance, and blood urea were found to show statistically significant difference in values preoperatively and postoperatively. It was observed that there was a statistically significant difference in the serum bilirubin values among patients of renal failure. Each case of surgical jaundice should be considered as a potential case likely to pass in acute renal failure, and hence, a close monitoring of renal functions should be started at the very beginning and should be continued until the final outcome of the treatment. 臨床上早已察覺到，外科性黃疸與術後急性腎衰竭 (ARF) 之間存在若干的關聯。事實上，外科性(阻塞性)黃疸頗為常見，然而患者卻可能在手術矯治後發生 ARF，明顯增加其死亡風險。 本研究以 50 位年齡 10–70 歲的阻塞性黃疸患者為對象，並透過問卷對其臨床背景作出調查；常規檢查項目則包括血液、糞尿、肝腎功能、及影像學檢查。所有與肝腎功能有關的檢查，分別於住院首天與第 3 天、及手術後第 2、7、與 14 天進行。 根據本研究的診斷標準，74 人於手術後第 2 天出現腎衰竭。在合計 7 項腎功能項目中，4 項在手術前後發生明顯的變化，它們包括血清肌酸酐、比重、inulin 清除率、及血液中尿素。在腎衰竭患者間，血清膽紅素亦呈現明顯差別。 每位外科性黃疸患者均應被視為可能發生急性腎衰竭的危險個案，因此必須從治療初期開始，接受密切的臨床追蹤包括腎功能檢查，直到療程的完成。