Alkhunaizi Ahmed M, ElTigani Mohamed A, Rabah Rola S, Nasr Samih H
Clin Nephrol. 2016 Feb;85(2):121-6. doi: 10.5414/CN108696.
Renal dysfunction in cholestatic liver disease is multifactorial. Acute kidney injury may develop secondary to renal vasoconstriction in the setting of peripheral vasodilation and relative hypovolemia, tubular obstruction by bile casts, and direct tubular toxicity from bile. Anabolic steroids are frequently used by athletes to boost endurance and increase muscle mass. These agents are a recently recognized cause of hepatotoxicity and jaundice and may lead to acute kidney injury. To increase awareness about this growing problem and to characterize the pathology of acute kidney injury in this setting, we report on a young male who developed acute kidney injury in the setting of severe cholestatic jaundice related to ingestion of anabolic steroids used for bodybuilding. Kidney biopsy showed bile casts within distal tubular lumina, filamentous bile inclusions within tubular cells, and signs of acute tubular injury. This report supports the recently re-emerged concept of bile nephropathy cholemic nephrosis.
胆汁淤积性肝病中的肾功能障碍是多因素的。在周围血管扩张和相对血容量不足的情况下，急性肾损伤可能继发于肾血管收缩、胆泥导致的肾小管梗阻以及胆汁对肾小管的直接毒性。运动员经常使用合成代谢类固醇来提高耐力和增加肌肉量。这些药物是最近才被认识到的肝毒性和黄疸的病因，可能导致急性肾损伤。为了提高对这一日益严重问题的认识，并明确这种情况下急性肾损伤的病理特征，我们报告了一名年轻男性，他在因摄入用于健美运动的合成代谢类固醇而导致严重胆汁淤积性黄疸的情况下发生了急性肾损伤。肾活检显示远端肾小管腔内有胆泥、肾小管细胞内有丝状胆汁包涵体以及急性肾小管损伤的迹象。本报告支持最近重新出现的胆汁性肾病/胆血症肾病的概念。
