Thompson J N, Carolan G, Myers M J, Blumgart L H
Department of Surgery, Royal Postgraduate Medical School, London, UK.
Acta Chir Scand. 1989 Sep;155(9):465-70.
Experimental alterations in renal haemodynamics have been observed in obstructive jaundice and these may be the pathophysiological mechanism of increased renal susceptibility to injury in obstructive jaundice. Dynamic 99mTc-DTPA renal scintigraphy was done before and eight weeks after elective hepatobiliary surgery in six patients with obstructive jaundice (bilirubin greater than 100 mumol/l) and in six non-jaundiced control patients to assess changes in glomerular filtration and renal blood flow. Glomerular filtration was lower preoperatively in the jaundiced patients than in the control patients. Glomerular filtration increased postoperatively in jaundiced patients, but decreased in control patients. Renal blood flow was reduced postoperatively in control patients, but not in jaundiced patients. The changes in renal blood flow were different for each group of patients. These results provide clinical evidence of altered renal haemodynamics and a reversible impairment of glomerular filtration in obstructive jaundice. The changes seen in renal blood flow may be the underlying mechanism of increased renal susceptibility to injury.
在梗阻性黄疸中已观察到肾脏血流动力学的实验性改变，这些改变可能是梗阻性黄疸时肾脏对损伤易感性增加的病理生理机制。对6例梗阻性黄疸患者（胆红素大于100μmol/L）和6例非黄疸对照患者在择期肝胆手术前及术后8周进行了动态99mTc - DTPA肾闪烁显像，以评估肾小球滤过和肾血流的变化。黄疸患者术前肾小球滤过率低于对照患者。黄疸患者术后肾小球滤过率增加，而对照患者术后降低。对照患者术后肾血流减少，而黄疸患者术后未减少。每组患者的肾血流变化不同。这些结果为梗阻性黄疸时肾脏血流动力学改变及肾小球滤过的可逆性损害提供了临床证据。肾血流的变化可能是肾脏对损伤易感性增加的潜在机制。
