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      Hypokalemia due to Fanconi Syndrome in a Patient with Obstructive Jaundice

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          There are limited data regarding tubular dysfunction in patients with obstructive jaundice. Here, we present a patient aged 79 years with protracted obstructive jaundice due to choledocholithiasis who developed hypokalemia with inappropriate kaliuria as a part of a non-acidotic generalized proximal tubular dysfunction, which included renal phosphate, uric acid and glucose wasting.

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          Partially reversible renal tubular damage in patients with obstructive jaundice.

           G Liamis,  O Tsolas,  M Elisaf (2001)
          Decreased serum uric acid levels resulting from renal urate wasting have been 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 with obstructive jaundice of various severity and causes (11 with lithiasis, 17 with carcinoma, and 7 with intrahepatic cholestasis). A detailed study of the renal tubular function was performed. Beyond the conventional methods, (1)H-NMR spectroscopy of urine was used to evaluate noninvasively renal damage by the characteristic perturbation in the excretion pattern of low-molecular weight endogenous metabolites. On admission, patients with obstructive jaundice had significantly lower serum uric acid and phosphate levels and higher bile acid concentrations compared with 40 age- and sex-matched controls. Serum uric acid levels presented a negative correlation with the total and direct bilirubin as well as the fractional excretion of uric acid. Furthermore, a great number of the patients studied developed one or more proximal tubular dysfunction manifestations beyond uricosuria, such as renal glucosuria, phosphaturia, and increased excretion of alpha(1)-microglobulin. (1)H-NMR spectroscopy of the urine showed decreased levels of citrate and hippurate and increased levels of 3-hydroxybutyrate and acetate. In 12 patients partial or complete remission of jaundice was followed by an improvement of the proximal renal tubular damage. In conclusion, obstructive jaundice can cause a partially reversible generalized proximal tubular dysfunction.

            Author and article information

            S. Karger AG
            September 2002
            26 September 2002
            : 92
            : 3
            : 711-712
            aDepartment of Internal Medicine, and bLaboratory of Biochemistry, Medical School, University of Ioannina, Greece
            64069 Nephron 2002;92:711–712
            © 2002 S. Karger AG, Basel

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