Jamshaid Muhammad B, Iqbal Phool, Shahzad Aamir, Yousaf Zohaib, Mohamedali Mohamed
Internal Medicine, Hamad General Hospital, Doha, QAT.
Medicine, Hamad General Hospital, Doha, QAT.
Cureus. 2020 Aug 13;12(8):e9724. doi: 10.7759/cureus.9724.
Acute kidney injury in the setting of hyperbilirubinemia presents a diagnostic challenge. Hepatorenal syndrome takes precedence as a diagnosis in these cases. Bile cast nephropathy is a diagnosis that gets relatively low consideration. The most accurate diagnostic tool for bile cast nephropathy is a renal biopsy, which may present a challenge in certain clinical settings. There are no set guidelines for its management. While the exact cause of the condition is unknown, it is presumed to be secondary to multiple concurrent insults to the kidney including direct toxicity from bile acids, obstruction caused by bile casts, and systemic hypo-perfusion from vasodilation. It is believed that plasmapheresis and albumin dialysis have been associated with some recovery of renal function. We present a case of acute renal failure in a patient with obstructive jaundice, who responded to dialysis and biliary drain insertion.
高胆红素血症背景下的急性肾损伤带来了诊断挑战。在这些病例中，肝肾综合征优先作为诊断考虑。胆汁管型肾病作为一种诊断相对较少被考虑。诊断胆汁管型肾病最准确的工具是肾活检，这在某些临床情况下可能具有挑战性。目前尚无针对其治疗的既定指南。虽然该病症的确切病因尚不清楚，但推测是继发于对肾脏的多种并发损伤，包括胆汁酸的直接毒性、胆汁管型引起的梗阻以及血管舒张导致的全身性低灌注。据信血浆置换和白蛋白透析与肾功能的部分恢复有关。我们报告一例梗阻性黄疸患者发生急性肾衰竭的病例，该患者对透析和胆管引流置入有反应。
