Impaired renal function in obstructive jaundice: roles of the thromboxane and endothelin systems.

Patients with intra- or extrahepatic bile-duct obstruction are susceptible to acute renal failure (ARF) especially when undergoing major surgery. We observed in jaundiced rats 4 days after bile-duct ligation (BDL) a decrease in GFR accompanied by polyuria which is associated with increased urinary thromboxane (TX) excretion and glomerular TXB2 synthesis. The TXA2/ PGH2 receptor antagonist daltroban normalized GFR but not urine concentration. There was also a rise in plasma and urinary endothelin (ET-1) with increased papillary ET synthesis. The ETA/ETB receptor blocker bosentan restored GFR and the renal concentrating ability. Since we showed previously that ET-induced decreases in renal perfusion and ultrafiltration coefficient Kf are mediated by other autacoids such as TX, this may explain why both bosentan and daltroban normalized GFR. These results suggest that increased renal glomerular TX and vascular and inner medullary collecting duct ET synthesis contribute to defective GFR and distal tubular function in experimental BDL. Similar alterations may also predispose the human kidney to ARF in patients with obstructive jaundice.