Human Kidney Histopathology in Obstructive Jaundice
Condition: Patients With Obstructive Jaundice
MeSH terms: Jaundice; Jaundice, Obstructive
Study type: Interventional
Phase: Phase 4

Summary: 
      Introduction: Cholemia and bacterial translocation with portal endotoxemia are integral in
      the pathogenesis of obstructive jaundice (OJ). There is sufficient experimental data about
      hemodynamic and histopathologic consequences of OJ. On the contrary, pathologic information
      of renal changes in patients with OJ is still lacking. Therefore; the primary objective of
      this prospective study is to demonstrate the specific histopathologic changes in kidneys of
      patients with short-term biliary tract obstruction receiving a standard perioperative medical
      treatment protocol.
    

Detailed description: 
      Twenty consecutive patients with biliary obstruction were included. Fluid replacement,
      prevention of biliary sepsis and portal endotoxemia were mainstays of the perioperative
      treatment protocol. Fluid and electrolyte balance was maintained by twice daily body weight
      calculations, central venous pressure and mean arterial pressure (MAP) monitoring . Renal
      function was assessed by glomerular filtration rate estimation via MDRD-7 formula.

      Kidney biopsy evaluation was focused on tubular changes, thrombotic microangiopathy,
      endothelial damage and peritubular capillary (PTC) dilatation with or without C4d staining.
      Fresh frozen sections were evaluated with immunoflourescence (IF)microscopy for glomerular
      IgG, IgA, IgM, C3, and C1q staining.

      Despite those favourable figures, dilatation of peritubular venules and acute tubular
      necrosis were demonstrated synchronously in all cases. C4d staining in PTC and arterioles and
      thrombotic microangiopathy were entirely absent in the study group. Immune complex deposits
      in peritubular capillaries and in glomeruli were not detected. Three patients had isolated
      glomerular C4d deposition without accompanying thrombotic microangiopathy and IgG, IgA, IgM,
      C3, and C1q staining of glomerular capillaries in IF microscopy.

      Discussion: This study is the first in the literature to address the histopathologic changes
      that occur in humans with short-term biliary obstruction. ATN and venous dilatation was
      observed in all biopsies, without exception, despite the maintenance of strict volume control
      in all patients. The adequacy of volume control may not be implicated in those results;
      rather a possible mechanism related to untrapped endotoxin in the gut lumen or systemic
      circulation might lead to prolonged peritubular capillary dilatation and hypoperfusion with
      synchronous acute tubular necrosis . Absolute recovery of renal function in all patients and
      the demonstration of solitary ATN with no microvascular-glomerular-interstitial inflammation
      or injury, suggests that the perioperative treatment regime in this study is fairly
      efficacious in short-term OJ.
    

Intervention name(s): Whipple operation,Hepaticojejunostomy
Intervention type(s): Procedure
Intervention description(s): Whipple operation, Hepaticojejunostomy
Other intervention name(s): Internal biliary drainage operations
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: Obstructive jaundice; kidney histopathology; lactulose