The Effects of Jaundice and Cholemia on Kidney Function and The Cardiovascular System

  • Jacob Green
  • Ori S. Better


It has been known for four decades that patients with obstructive jaundice are at a high risk for postoperative acute renal failure (1–4). These patients also have greater falls in blood pressure following modest blood loss than patients without jaundice. The search for the cause of these complications of obstructive jaundice and attempts at prophylactic treatment in jaundiced patients undergoing surgery have prompted extensive experiments on animals with chronic bile duct ligation (CBDL) or animals in which the entire bile flow is diverted from the common bile duct to the systemic circulation-choledochocaval anastomosis (CDCA). While extrapolation to humans of conclusions obtained in animal studies should be made with caution, a growing body of evidence now suggests that bile constituents (e.g., bile acids, bilirubin, cholesterol) do not exert a direct nephrotoxic effect. Rather, retention of bile during cholestatic jaundice has deleterious effects on cardiovascular function and on blood volume. This, in turn, sensitizes the kidney to prerenal failure and acute tubular necrosis in postsurgical patients with obstructive jaundice.


Bile Acid Bile Salt Obstructive Jaundice Bile Duct Ligation Jaundice Patient 
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Copyright information

© Springer Science+Business Media New York 1998

Authors and Affiliations

  • Jacob Green
    • 1
  • Ori S. Better
    • 2
  1. 1.Department of NephrologyRambam Medical CenterBat Galim, HaifaIsrael
  2. 2.Department of Nephrology Rambam Medical CenterThe B. Rappaport Faculty of Medicine Technion, Israel Institute of TechnologyHaifaIsrael

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