Open AccessBile cast nephropathy causing acute kidney injury in a patient with nonfulminant acute hepatitis A
Author(s) -
Ranjani Ravi,
Kedar Suthar,
Praveen Murlidharan,
Kameswari Lakshmi,
Satish Balan,
Mohammed Safeer
Publication year - 2018
Publication title -
saudi journal of kidney diseases and transplantation/našrat amraḍ wa zira'aẗ al-kulaẗ
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.268
H-Index - 30
eISSN - 2320-3838
pISSN - 1319-2442
DOI - 10.4103/1319-2442.248305
Subject(s) - medicine , acute tubular necrosis , acute kidney injury , jaundice , nephropathy , gastroenterology , nephrosis , hepatitis , renal biopsy , cholestasis , hemodialysis , kidney , endocrinology , diabetes mellitus
Hepatitis A is usually a benign self-limiting disease with few or no extrahepatic manifestations. Acute hepatitis A causing severe renal dysfunction is not very common, although described. Patients developing renal dysfunction post hepatitis A infection usually have prerenal acute kidney injury (AKI) or acute tubular necrosis due to vomiting, diarrhea, and poor fluid replacement. However, if renal dysfunction persists, other causes need to be evaluated. The term cholemic nephrosis or more specifically bile cast nephropathy has been described in the setting of cholestatic jaundice and decompensated liver failure where bilirubin levels reach above 20 mg/dL. Herein, we describe the clinical course of a patient who developed acute hepatitis A with severe liver dysfunction and subsequently AKI which persisted for six weeks. Renal biopsy showed the evidence of bile cast nephropathy. After six weeks of hemodialysis, urine output improved. He slowly recovered both hepatic and renal functions.