Fisler Andrea, Breidthardt Tobias, Schmidlin Nadine, Hopfer Helmut, Dickenmann Michael, König Katrin, Hirt-Minkowski Patricia
Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland.
Division of Internal Medicine, University Hospital Basel, Basel, Switzerland.
Case Rep Nephrol Dial. 2018 May 31;8(2):98-102. doi: 10.1159/000489771. eCollection 2018 May-Aug.
Renal dysfunction in the setting of cholestatic liver disease is multifactorial but most often due to decreased kidney perfusion from intravascular volume depletion, acute tubular injury/necrosis, and hepatorenal syndrome. Drug-induced hepatotoxicity may be associated with a cholestatic injury pattern. We report a case of a 56-year-old man with a diagnosis of bile cast nephropathy, as a complication of drug-induced severe hyperbilirubinemia due to the abuse of intramuscular anabolic steroids bought on the internet to increase muscular mass for bodybuilding training. Kidney biopsy showed the histological pattern of diffuse potentially reversible tubular damage with intratubular bile casts obstructing the renal tubules. The patient developed acute kidney injury and needed dialysis treatment for 4 weeks until renal function recovered. The severity of the kidney injury and the requirement of hemodialysis observed in our patient are unique and have not been previously described. As full recovery of renal function is suspected with decreasing bilirubin levels, early recognition and treatment of the underlying disease is essential.
