Bile cast nephropathy: A case report and review of the literature

• Published in: World journal of gastroenterology : WJG 2016-07, Vol.22 (27), p.6328-6334
• Main Authors: Patel, Jaymon, Walayat, Saqib, Kalva, Nikhil, Palmer-Hill, Sidney, Dhillon, Sonu
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - etiology; Acute Kidney Injury - pathology; Acute Kidney Injury - therapy; Adrenal Cortex Hormones - therapeutic use; Anion Exchange Resins - therapeutic use; Anti-Bacterial Agents - adverse effects; Bile; Biopsy; Case Report; cast; Dialysis; Drug-induced; Chemical and Drug Induced Liver Injury, Chronic - etiology; Cholagogues and Choleretics - therapeutic use; Cholestyramine Resin - therapeutic use; Humans; Hyperbilirubinemia - chemically induced; Hyperbilirubinemia - complications; injury; Plasmapheresis; Hyperbilirubinemia; Jaundice, Obstructive - chemically induced; Jaundice, Obstructive - drug therapy; liver; Male; Middle Aged; Osteomyelitis - drug therapy; Penicillanic Acid - adverse effects; Penicillanic Acid - analogs & derivatives; Piperacillin - adverse effects; Plasmapheresis; Renal Dialysis; Renal Insufficiency, Chronic - complications; Ursodeoxycholic Acid - therapeutic use
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v22.i27.6328

Bile cast nephropathy is a condition of renal dysfunction in the setting of hyperbilirubinemia. There are very few cases of this condition reported in the last decade and a lack of established treatment guidelines. While the exact etiology remains unknown, bile cast nephropathy is presumed to be secondary to multiple concurrent insults to the kidney including direct toxicity from bile acids, obstructive physiology from bile casts, and systemic hypoperfusion from vasodilation. Therapy directed at bilirubin reduction may improve renal function, but will likely need dialysis or plasmapheresis as well. We report our case of bile cast nephropathy and the therapeutic measures undertaken in a middle-aged male with chronic renal insufficiency that developed hyperbilirubinemia and drug-induced liver injury secondary to antibiotic use. He developed acute renal injury in the setting of rising bilirubin. He subsequently had a progressive decline in renal and hepatic function, requiring dialysis and plasmapheresis with some improvement, ultimately requiring transplantation.