Korean J Gastroenterol.  2020 Mar;75(3):167-171. 10.4166/kjg.2020.75.3.167.

Liver Graft Failure and Bile Cast Nephropathy

Affiliations
  • 1Department of Internal Medicine, Merkur University Hospital, Zagreb, Croatia. anna.mrzljak@mef.hr
  • 2Department of Medicine, School of Medicine, University of Zagreb, Zagreb, Croatia.
  • 3Department of Surgery, Merkur University Hospital, Zagreb, Croatia.
  • 4Unit for Renal Pathology and Electron Microscopy, Department of Pathology and Cytology, Dubrava University Hospital, Zagreb, Croatia.

Abstract

The consequences of graft failure after liver transplantation (LT) range far beyond the liver. The kidneys are often affected, where persistent and progressive cholestasis can result in acute kidney injury (AKI) leading to the development of bile cast nephropathy (BCN). BCN is an often unrecognized condition that is characterized by proximal tubulopathy and the formation of bile casts in the distal tubules, which is almost diagnosed exclusively on a kidney biopsy or autopsy. This condition is potentially reversible, provided the bilirubin levels can be reduced early. LT may represent a treatment option in the case of irreversible liver (or liver graft) failure, which is beneficial for both the liver and the kidney. This paper reports a case of BCN in a patient with idiopathic graft failure after LT. Despite his chronic kidney disease, liver re-transplantation led to the successful improvement of his AKI.

Keyword

Liver transplantation; Liver failure; Cholestasis; Acute kidney injury; Hyperbilirubinemia

MeSH Terms

Acute Kidney Injury
Autopsy
Bile*
Bilirubin
Biopsy
Cholestasis
Humans
Hyperbilirubinemia
Kidney
Liver Failure
Liver Transplantation
Liver*
Renal Insufficiency, Chronic
Transplants*
Bilirubin
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