Section of Nephrology, Yale University School of Medicine, New Haven, CT.
Department of Pathology, Yale University School of Medicine, New Haven, CT.
Am J Kidney Dis. 2014 Sep;64(3):473-6. doi: 10.1053/j.ajkd.2014.05.010. Epub 2014 Jun 18.
Bile acid nephropathy, also known as cholemic nephrosis or nephropathy, is an entity that can be seen in patients with severe cholestatic liver disease. It typically is associated with acute kidney injury (AKI) with various forms of hepatic disease. Most often, patients with severe obstructive jaundice develop this lesion, which is thought to occur due to direct bile acid injury to tubular cells, as well as obstructing bile acid casts. Patients with end-stage liver disease also can develop AKI, in which case a more heterogeneous lesion occurs that includes hepatorenal syndrome and acute tubular injury/necrosis. In this circumstance, acute tubular injury develops from a combination of hemodynamic changes with some contribution from direct bile acid-related tubular toxicity and obstructive bile casts. We present a case of AKI due to bile acid nephropathy in a bodybuilder who developed severe cholestatic liver disease in the setting of anabolic androgenic steroid use.
胆酸肾病，亦称胆性肾病或肾病，是一种可在严重胆汁淤积性肝病患者中见到的病症。它通常与各种形式的肝疾病相关的急性肾损伤（AKI）相关联。最常见的是，患有严重梗阻性黄疸的患者会出现这种病变，这被认为是由于直接的胆汁酸对肾小管细胞的损伤以及阻塞性的胆汁酸管型所致。终末期肝病患者也可能发生 AKI，在这种情况下，病变更为复杂，包括肝肾综合征和急性肾小管损伤/坏死。在这种情况下，急性肾小管损伤是由血流动力学变化引起的，同时也有一些直接与胆汁酸相关的肾小管毒性和阻塞性胆汁酸管型的贡献。我们报告了一例由于胆酸肾病导致 AKI 的病例，该患者是一名健美运动员，在使用合成代谢雄激素类固醇后发生严重的胆汁淤积性肝病。
