Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Friday, 08 / 18 / 2017

Articles

Bile Cast Nephropathy in Patients with Acute Kidney Injury Due to Hepatorenal Syndrome: A Postmortem Kidney Biopsy Study

ORIGINAL ARTICLE

Bile Cast Nephropathy in Patients with Acute Kidney Injury Due to Hepatorenal Syndrome: A Postmortem Kidney Biopsy Study

Suman Lata Nayak#,1, Manoj Kumar#*,2, Chhagan Bihari3 and Archana Rastogi3

1Department of Nephrology, Institute of Liver and Biliary Sciences, New Delhi, India
2Department of Hepatology and Liver Transplatation, Institute of Liver and Biliary Sciences, New Delhi, India
3Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India

*Correspondence to: Manoj Kumar, Department of Hepatology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi 110070, India. Tel: +91-11-46300000, Fax: +91-11-46300063, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2017;5(2):92-100 DOI: 10.14218/JCTH.2016.00063
Received: November 15, 2017 Accepted: March 31, 2017 Published online: May 4, 2017

Abstract

Background and Aims: The role of bile cast nephropathy (BCN) in pathogenesis of hepatorenal syndrome (HRS) in decompensated cirrhosis and acute on chronic liver failure (ACLF) is unknown. This study aimed to determine the frequency of BCN detected on postmortem renal biopsy among patients with decompensated cirrhosis and ACLF who had been admitted with acute kidney injury due to HRS (HRA-AKI) and expired during that hospitalization.

Methods: One-hundred-twenty-seven postmortem renal biopsies with adequate size (>1 cm in length) were included for analysis. These were obtained from 84 patients with decompensated cirrhosis and 43 patients with ACLF.

Results: BCN was detected in 57 of the total 127 (44.8%) renal biopsy specimens. Patients with BCN had significantly higher levels of serum total bilirubin, total leukocyte count and model for end-stage liver disease score, as compared to those without BCN. BCN was detected in 32/43 (74.4%) of the patients with ACLF, as compared to 25/84 (29.7%) of the patients with decompensated cirrhosis (p < 0.001). On multivariate analysis, direct bilirubin (OR (95% CI): 1.27 (1121–1.698); p < 0.001) and presence of ACLF (OR (95% CI): 2.603 (1.054–7.111); p = 0.041) were found to be significant predictors of BCN on postmortem renal biopsy.

Conclusion: BCN was found in 72.1% of patients with ACLF and 27.4% patients with decompensated cirrhosis who had been hospitalized with an admitting diagnosis of HRS-AKI and who expired during that hospitalization and underwent postmortem renal biopsy. Direct serum bilirubin and presence of ACLF were found to be significant predictors of BCN on postmortem renal biopsy.

Keywords

Bile cast nephropathy, Acute kidney injury, Hepatorenal syndrome

 

Journal of Clinical and Translational Hepatology 2017 vol. 5, 1-8  Html ] [ PDF Full-text ]

© The Authors 2017. This article is published under the terms of the Creative Commons Attribution-Noncommercial (CC BY-NC) License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.

 

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