Foshat Michelle, Ruff Heather M, Fischer Wayne G, Beach Robert E, Fowler Mark R, Ju Hyunsu, Aronson Judith F, Afrouzian Marjan
Department of Pathology.
Division of Nephrology, Department of Internal Medicine.
Am J Clin Pathol. 2017 May 1;147(5):525-535. doi: 10.1093/ajcp/aqx030.
The aim of this study was to determine the prevalence of bile cast nephropathy (BCN) in autopsied cirrhotic patients and to correlate BCN with clinical and laboratory data to direct attention to this underrecognized renal complication of liver failure.
We assessed 114 autopsy cases of cirrhosis for the presence of renal intratubular bile casts using Hall stain for bile. Presence of bile casts was correlated with etiology of cirrhosis, clinical and laboratory data, and histologic findings.
Bile casts were identified in 55% of cases. The most common etiology of cirrhosis was hepatitis C virus (HCV) infection (52%), and serum creatinine ( P = .02) and serum urea nitrogen ( P = .01) were significantly higher in the Hall-positive group. Conjugated bilirubin was below 20 mg/dL in 90%, and levels below 10 mg/dL were noted in 80% of cases.
To our knowledge, this is the largest study of BCN in human subjects and a first report describing the association of BCN with HCV-related cirrhosis. We demonstrated that in the face of protracted chronic hyperbilirubinemia, bile casts are formed at much lower bilirubin levels than previously thought. Furthermore, we proposed an algorithm to assist in better identification of bile casts.
本研究旨在确定尸检肝硬化患者胆汁管型肾病（BCN）的患病率，并将BCN与临床和实验室数据相关联，以引起对这种未被充分认识的肝衰竭肾脏并发症的关注。
我们使用胆汁霍尔染色评估了114例肝硬化尸检病例肾小管内胆汁管型的存在情况。胆汁管型的存在与肝硬化病因、临床和实验室数据以及组织学发现相关。
55%的病例中发现了胆汁管型。肝硬化最常见的病因是丙型肝炎病毒（HCV）感染（52%），霍尔染色阳性组的血清肌酐（P = 0.02）和血清尿素氮（P = 0.01）显著更高。90%的病例结合胆红素低于20mg/dL，80%的病例低于10mg/dL。
据我们所知，这是对人类受试者BCN进行的最大规模研究，也是首次描述BCN与HCV相关肝硬化关联的报告。我们证明，在长期慢性高胆红素血症的情况下，胆汁管型在比先前认为的低得多的胆红素水平下形成。此外，我们提出了一种算法以协助更好地识别胆汁管型。
