Patel Jaymon, Walayat Saqib, Kalva Nikhil, Palmer-Hill Sidney, Dhillon Sonu
Jaymon Patel, Sidney Palmer-Hill, Department of Internal Medicine, University of Illinois Peoria Campus, OSF Saint Francis Medical Center, Peoria, IL 61637, United States.
World J Gastroenterol. 2016 Jul 21;22(27):6328-34. doi: 10.3748/wjg.v22.i27.6328.
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.
胆汁管型肾病是一种在高胆红素血症情况下出现的肾功能障碍疾病。在过去十年中，这种疾病的报道病例非常少，并且缺乏既定的治疗指南。虽然确切病因尚不清楚，但胆汁管型肾病被认为是继发于多种同时对肾脏的损害，包括胆汁酸的直接毒性、胆汁管型引起的梗阻性生理状态以及血管舒张导致的全身低灌注。针对降低胆红素的治疗可能会改善肾功能，但可能也需要透析或血浆置换。我们报告了一例胆汁管型肾病病例以及针对一名患有慢性肾功能不全的中年男性所采取的治疗措施，该患者因使用抗生素继发高胆红素血症和药物性肝损伤。在胆红素升高的情况下，他出现了急性肾损伤。随后，他的肾功能和肝功能逐渐下降，需要进行透析和血浆置换，病情有所改善，最终需要进行移植。
