Research Unit for Experimental and Molecular Hepatology, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Austria.
Institute of Pathology, Department of Internal Medicine, Medical University of Graz, Austria.
Biochim Biophys Acta Mol Basis Dis. 2018 Apr;1864(4 Pt B):1356-1366. doi: 10.1016/j.bbadis.2017.08.028. Epub 2017 Aug 26.
Acute kidney injury is common in patients with liver disease and associated with significant morbidity and mortality. Besides bacterial infections, fluid loss, and use of nephrotoxic drugs AKI in liver disease may be triggered by tubular toxicity of cholephiles. Cholemic nephropathy, also known as bile cast nephropathy, supposedly represents a widely underestimated but important cause of renal dysfunction in cholestasic or advanced liver diseases with jaundice. Cholemic nephropathy describes impaired renal function along with characteristic histomorphological changes consisting of intratubular cast formation and tubular epithelial cell injury directed towards distal nephron segments. The underlying pathophysiologic mechanisms are not entirely understood and clear defined diagnostic criteria are still missing. This review aims to summarize (i) the present knowledge on clinical and morphological characteristics of cholemic nephropathy, (ii) available preclinical models, (iii) potential pathomechanisms especially the potential role of bile acids, and (iv) future diagnostic and therapeutic strategies for cholemic nephropathy. This article is part of a Special Issue entitled: Cholangiocytes in Health and Disease edited by Jesus Banales, Marco Marzioni, Nicholas LaRusso and Peter Jansen.
急性肾损伤在肝病患者中很常见，与显著的发病率和死亡率相关。除了细菌感染、液体流失和使用肾毒性药物外，AKI 在肝病中也可能由胆盐的肾小管毒性引发。胆血性肾病，也称为胆砂肾病，据推测是胆汁淤积或伴有黄疸的晚期肝病中肾功能障碍的一个被广泛低估但重要的原因。胆血性肾病描述了伴有特征性组织形态学改变的肾功能损害，包括管腔内铸型形成和向远端肾单位段的肾小管上皮细胞损伤。其潜在的病理生理机制尚不完全清楚，也没有明确的诊断标准。这篇综述旨在总结（i）胆血性肾病的临床和形态学特征的现有知识，（ii）现有的临床前模型，（iii）潜在的发病机制，特别是胆汁酸的潜在作用，以及（iv）胆血性肾病的未来诊断和治疗策略。本文是由 Jesus Banales、Marco Marzioni、Nicholas LaRusso 和 Peter Jansen 编辑的题为“健康与疾病中的胆管细胞”特刊的一部分。
