In the patient with obstructive jaundice, preliminary dehydration, combined with the toxic effects of free bilirubin and serum bile acids, together with factors which cause inhibition of fibrinolysis, determine a high degree of renal susceptibility to ischaemia. Evidence from animals and man suggests that intravascular coagulation determined by endotoxaemia from the obstructed biliary system occurs at the onset of acute renal failure. Endotoxin is unique in being able to produce all those factors which separately cause a primary increase of renal arteriolar constriction.
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