Betjes Michiel G H, Bajema Ingeborg
Division of Nephrology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
J Nephrol. 2006 Mar-Apr;19(2):229-33.
The spectrum of jaundice-related nephropathy can range from limited proximal tubulopathy to renal failure. The latter condition was known as cholemic nephrosis in the early literature on this subject. Elevated plasma concentrations of bile salts and bilirubin conjugated or not, putatively mediate the nephrotoxicity. A functional derangement of renal tubule cells is considered to underlie the nephropathy, but published data on renal histology are scarce. In this report, we describe the renal biopsies of two jaundiced patients with reduced creatinine clearance, and we critically review the literature on the pathogenesis of jaundice-related nephropathy. Normal renal architecture, indicating functional renal impairment, and extensive renal tubule necrosis were both observed in jaundice-related renal failure. The findings fit the original description of cholemic nephrosis. Both bilirubin and bile salts are potential nephrotoxins in animal models, but their precise role in the pathogenesis of jaundice-related nephropathy is not known. Patients with bilirubin plasma concentrations >20 mg/dL, a low serum albumin concentration or endo-toxemia, could be more prone to develop renal failure due to jaundice-related tubulopathy. In conclusion, jaundice-related nephropathy is essentially a tubulopathy, but the exact nature of the Pathogenesis is still uncertain.
黄疸相关性肾病的范围可从局限性近端肾小管病变到肾衰竭。在关于该主题的早期文献中，后一种情况被称为胆血症性肾病。无论结合与否，血浆中胆汁盐和胆红素浓度升高被认为是介导肾毒性的原因。肾小管细胞的功能紊乱被认为是肾病的基础，但关于肾脏组织学的已发表数据很少。在本报告中，我们描述了两名肌酐清除率降低的黄疸患者的肾活检情况，并对黄疸相关性肾病发病机制的文献进行了批判性综述。在黄疸相关性肾衰竭中，观察到了正常的肾脏结构（提示功能性肾功能损害）和广泛的肾小管坏死。这些发现符合胆血症性肾病的最初描述。在动物模型中，胆红素和胆汁盐都是潜在的肾毒素，但它们在黄疸相关性肾病发病机制中的确切作用尚不清楚。血浆胆红素浓度>20mg/dL、血清白蛋白浓度低或存在内毒素血症的患者，可能更容易因黄疸相关性肾小管病变而发生肾衰竭。总之，黄疸相关性肾病本质上是一种肾小管病变，但其发病机制的确切性质仍不确定。
