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Bile cast nephropathy: An often forgotten diagnosis
Author(s) -
Sequeira Adrian,
Gu Xin
Publication year - 2015
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/hdi.12169
Subject(s) - medicine , acute kidney injury , tubulopathy , nephropathy , dialysis , bilirubin , renal biopsy , acute tubular necrosis , myoglobinuria , hemodialysis , anuria , gastroenterology , prednisolone , urology , nephrotoxicity , kidney disease , kidney , endocrinology , rhabdomyolysis , diabetes mellitus
High bilirubin levels are nephrotoxic. Bilirubin can cause a functional proximal tubulopathy or may precipitate into casts associated with acute tubular injury. This condition is known as bile cast nephropathy. The kidney injury is generally reversible if bilirubin levels are decreased early. We present a case wherein an alcoholic patient presented with high bilirubin levels and anuric acute kidney injury. The initial urine analysis suggested intrinsic renal disease. A kidney biopsy, performed a few days after the initiation of dialysis, demonstrated the presence of bile casts along with acute tubular injury. The patient however continued to be dialysis dependent inspite of initiating prednisolone to treat acute alcoholic hepatitis.