It is generally agreed that the acute renal failure is not an infrequent complication among the patient with deep obstructive jaundice, particularly during immediate post-operative period. This is also considered due to deposit of bile pigment in the renal tubule and resulting functio-nal derrangements.
Investigations were therefore conducted to see if the use of an osmotic diuretics {mannitol) has any beneficial effect in these situation.
Fourteen Korean female mongrel dogs were used in the experiments. After a preliminary blood chemical studies, obstructive jaundice was created by ligating common bile ducts of all animals. After a period of 3 weeks during which the jaundice reached desirable level, the animals were deviled into two groups. One group of 7 dogs received saline infusions on 2 successive days and the other of 7 dogs received 2 ml of 25% mannitol per kg body, weight in two divided dose during the two days in addition to the normal saline as in the control group.
Following observations were made as the results;
1. All dogs showed progressive weight loss of 1-2 kg during the 3 weeks.
2. Serum bilirubin level increased steadily, reaching the peak of 6.7mg %. This level is con-sidered maximum level attainable in dogs while the level may go up much higher in human beings.
3. Serum transaminase, especially the S-GPT, and alkaline phosphatase activity increased greatly.
4.Twenty-four hour urine volume decreased significantly during the jaundiced period, and thismade, a good contrast to thee increase in urine creatinine level.
5. Marked fall in endogenous creatinine clearance was observed in all jaundiced animal. In dogs which received mannitol diuresis, however, the fall in creatinine clearance could be almost completely prevented or reversed.
6. The most striking morphological feature of liver in these animals was ass expected choler tasis, ´which resulted in the dilatiaton of ductules and the bile plugs in canaliculi with a preponderance in the centrilobular area. Diffuse precipitation of bile pigmented granulues both in liver cells and in Kupffer cells was observed as was the infiltration of inflammatory cells´ in portal tracts.
7. The kidneys were diffusely stained with bile. The glomeruli contained a small amount of faintly eosinophilic material and precipitated protein in the Bowman´s space. Deposit of granular or amorphous, yellow green to brown bile was found in the tubular epithelium of the proximal nephron. Degenerative changes and necrosis of the proximal tubular epithelium with associated interstitial, lymphocytic and plasma cell infiltration were also present. All these findings were somewhat conspicuous among the group receiving mannitol diuresis.
On the basis of above observations, prophylactic mannitol administration appears to exert beneficial effect in jaundiced animal by preventing or minimizing the accompanying fall in glomerular filtration rate and cholemic changes.
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