van de Ven Steffi Em, Pavlov Kirill V, Beutler Jaap J, Scheffer Robbert Ch
Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
Department of Nephrology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
ACG Case Rep J. 2018 Dec 5;5:e88. doi: 10.14309/crj.2018.88. eCollection 2018.
Bile cast nephropathy is an often overlooked condition of acute renal injury in the setting of high serum bilirubin. While the exact pathophysiology remains unknown, possible mechanisms of renal injury are tubular obstruction from bile casts, direct toxicity from bile acids, and decreased renal perfusion due to hemodynamic changes. We present a patient with hyperbilirubinemia as a result of common bile duct obstruction due to pancreatic adenocarcinoma who developed anuric acute renal injury. Urine analysis showed bile casts that were highly suggestive for bile cast nephropathy. The patient underwent hemodialysis and bile drainage with full restoration of renal function.
胆汁管型肾病是高血清胆红素情况下一种常被忽视的急性肾损伤病症。虽然确切的病理生理学仍不清楚，但肾损伤的可能机制包括胆汁管型导致的肾小管梗阻、胆汁酸的直接毒性以及血流动力学变化引起的肾灌注减少。我们报告一名因胰腺腺癌导致胆总管梗阻而出现高胆红素血症的患者，该患者发展为无尿性急性肾损伤。尿液分析显示有胆汁管型，强烈提示胆汁管型肾病。该患者接受了血液透析和胆汁引流，肾功能完全恢复。
