To the Editor.
—I read with interest the article by Gregory1 regarding a patient in whom acute renal insufficiency developed following injections of water-soluble radiologic contrast material for transhepatic cholangiography. The development of acute renal failure as a complication of obstructive jaundice has been well described by a number of authors and is typically seen in a patient who is severely dehydrated, as this patient may have been. The author mentions, in the final discussion, that saline volume expansion would be helpful in prophylaxis from acute renal failure in this sort of patient; however, he failed to mention the protective effects of mannitol, which have been demonstrated by Dawson,2,3 in both animal and clinical trials in the 1960s.The mechanism of mannitol protection is not clearly understood, but is probably relatively safe in this sort of patient and has had demonstrated benefit as prophylaxis.
Tannenbaum JS. Acute Renal Failure as a Complication of Obstructed Jaundice. Arch Intern Med. 1985;145(1):178. doi:10.1001/archinte.1985.00360010226044