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Saudi Journal of Kidney Diseases and Transplantation
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CASE REPORT Table of Contents   
Year : 2018  |  Volume : 29  |  Issue : 6  |  Page : 1498-1501
Bile cast nephropathy causing acute kidney injury in a patient with nonfulminant acute hepatitis A

1 Department of Nephrology, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, India
2 Department of Pathology, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, India

Correspondence Address:
Dr. Ranjani Ravi
Department of Nephrology, Kerala Institute of Medical Sciences, Anayara PO, Thiruvananthapuram -695 029, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1319-2442.248305

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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.

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