Partially reversible renal tubular damage in patients with obstructive jaundice

Decreased serum uric acid levels resulting from renal urate wasting have be en occasionally encountered in jaundiced patients. However, in these cases, there are no data concerning the underlying renal tubular defects. In the present study, we investigated the renal tubular function in 35 patients wi th obstructive jaundice of various severity and causes (11 with lithiasis, 17 with carcinoma, and 7 with intrahepatic cholestasis). A detailed study o f the renal tubular function was performed. Beyond the conventional methods ,H-1-NMR spectroscopy of urine was used to evaluate noninvasively renal dam age by the characteristic perturbation in the excretion pattern of low-mole cular weight endogenous metabolites. On admission, patients with obstructiv e jaundice had significantly lot-ver serum uric acid and phosphate levels a nd higher bile acid concentrations compared with 40 age- and sex-matched co ntrols. Serum uric acid levels presented a negative correlation with the to tal and direct bilirubin as well as the fractional excretion of uric acid. Furthermore, a great number of the patients studied developed one or more p roximal tubular dysfunction manifestations beyond uricosuria, such as renal glucosuria, phosphaturia, and increased excretion of alpha (1)-microglobul in. H-1-NMR spectroscopy of the urine showed decreased levels of citrate an d hippurate and increased levels of 3-hydroxybutyrate and acetate. In 12 pa tients partial or complete remission of jaundice was followed by an improve ment of the proximal renal tubular damage. In conclusion, obstructive jaund ice can cause a partially reversible generalized proximal tubular dysfuncti on.