Bile Cast Nephropathy: A Pathologic Finding with Manifold Causes Displayed in an Adult with Alcoholic Steatohepatitis and in a Child with Wilson's Disease

Jose Torrealba, Nathan T. Sweed, Daniel Burguete, Allen R. Hendricks

Research output: Contribution to journalArticle

Abstract

Bile cast nephropathy (BCN) is seen in patients who have acute kidney injury and severe hyperbilirubinemia due to a wide range of hepatobiliary system diseases. Findings seen by renal biopsy include acute tubular injury with necrotic and sloughed epithelial cells, yellow-green pigment within tubular epithelial cells, and pigmented granular casts. Hall's special stain for bile turns these casts green. In recent years, BCN has been described in a small number of case reports and clinical studies primarily in the setting of severe liver dysfunction. We present 2 diverse cases of BCN. The first involves an adult with hepatorenal syndrome secondary to alcoholic steatohepatitis and early cirrhosis. Second, we describe the first reported case of BCN in a child with fulminant hepatic failure due to Wilson's disease. Our cases expand the spectrum of causative diseases, and they provide further evidence that BCN is a distinct pathologic entity which may be found in both adult and pediatric patients with a variety of severe liver diseases.

Original languageEnglish (US)
Pages (from-to)207-215
Number of pages9
JournalCase Reports in Nephrology and Dialysis
DOIs
StateAccepted/In press - Jan 1 2018

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Alcoholic Fatty Liver
Hepatolenticular Degeneration
Bile
Liver Diseases
Epithelial Cells
Hepatorenal Syndrome
Hyperbilirubinemia
Acute Liver Failure
Acute Kidney Injury
Fibrosis
Coloring Agents
Pediatrics
Kidney
Biopsy
Wounds and Injuries

ASJC Scopus subject areas

  • Nephrology

Cite this

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