Patel J, Walayat S, Kalva N, Palmer-Hill S, Dhillon S. Bile cast nephropathy: A case report and review of the literature. World J Gastroenterol 2016; 22(27): 6328-6334 [PMID: 27468221 DOI: 10.3748/wjg.v22.i27.6328]
Corresponding Author of This Article
Jaymon Patel, MD, Department of Internal Medicine, University of Illinois Peoria Campus, OSF Saint Francis Medical Center, 530 NE Glen Oak Ave, Peoria, IL 61637, United States. Jaymon.b.patel@osfhealthcare.org
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jul 21, 2016; 22(27): 6328-6334 Published online Jul 21, 2016. doi: 10.3748/wjg.v22.i27.6328
Bile cast nephropathy: A case report and review of the literature
Jaymon Patel, Saqib Walayat, Nikhil Kalva, Sidney Palmer-Hill, Sonu Dhillon
Jaymon Patel, Sidney Palmer-Hill, Department of Internal Medicine, University of Illinois Peoria Campus, OSF Saint Francis Medical Center, Peoria, IL 61637, United States
Saqib Walayat, Nikhil Kalva, Sonu Dhillon, Department of Gastroenterology and Hepatology, University of Illinois Peoria, Campus, OSF Saint Francis Medical Center, Peoria, IL 61637, United States
Author contributions: Patel J, Walayat S and Kalva N reviewed the literature, drafted the manuscript and approved the final version of the article to be published; Dhillon S reviewed the literature, made critical revisions related to the content of the article and approved the final version of the article to be published; Palmer-Hill S edited the article to be published.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at the University Of Illinois College Of Medicine in Peoria.
Informed consent statement: The patient involved in this study gave his written consent authorizing use and disclosure of his protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jaymon Patel, MD, Department of Internal Medicine, University of Illinois Peoria Campus, OSF Saint Francis Medical Center, 530 NE Glen Oak Ave, Peoria, IL 61637, United States. Jaymon.b.patel@osfhealthcare.org
Telephone: +1-650-7877489
Received: December 30, 2015 Peer-review started: December 31, 2015 First decision: January 28, 2016 Revised: February 29, 2016 Accepted: March 18, 2016 Article in press: March 18, 2016 Published online: July 21, 2016 Processing time: 198 Days and 3.2 Hours
Abstract
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.
Core tip: The role of bilirubin in causing acute renal insufficiency is not well known. Our case report is one of few documenting evidence of renal insufficiency as a result of hyperbilirubinemia. Diagnosis requires a high index of suspicion in patients with hyperbilirubinemia with concomitant acute renal insufficiency. Renal biopsy is the solitary means of definitive diagnosis. Treatment is targeted at improving hepatic dysfunction and decreasing bilirubin burden. Numerous treatment modalities to reduce bilirubin have been suggested with variable outcomes.
