3 research outputs found
Cholemic nephropathy causes acute kidney injury and is accompanied by loss of aquaporin 2 in collecting ducts
Impairment of renal function often occurs in patients with liver disease. Hepatorenal
syndrome is a significant cause of acute kidney injury (AKI) in cirrhotic patients
(HRS-AKI, type 1). Causes of non-HRS AKI include cholemic nephropathy (CN), a
disease that is characterized by intratubular bile casts and tubular injury. As data on
patients with CN is mostly obtained from case reports or autopsy studies, we aimed
to investigate the frequency and clinical course of CN. We identified 149 patients who
underwent kidney biopsy between 2000 to 2016 at the Department of
Gastroenterology, Hepatology and Endocrinology. Of these, 79 had a history of liver
disease and deterioration of renal function. When applying recent EASL criteria 45 of
the 79 patients (57%) presented with AKI, whereas 34 patients (43%) had chronic
kidney disease (CKD) (43%). Renal biopsy revealed the diagnosis of CN in 8 of the
45 patients with AKI (17.8%), whereas none of the patients with CKD was diagnosed
with CN. Univariate analysis identified serum bilirubin, alkaline phosphatase and
urinary bilirubin and urobilinogen as predictive factors for the diagnosis of CN.
Histological analysis of AKI patients with normal bilirubin, elevated bilirubin and the
diagnosis of CN revealed loss aquaporin 2 (AQP2) expression in collecting ducts in
patients with elevated bilirubin and CN. Biopsy related complications requiring
medical intervention occurred in four of 79 patients (5.1%).
In conclusion, CN is a common finding in patients with liver disease, AKI and highly
elevated bilirubin. Loss of AQP2 in AKI patients with elevated bilirubin and CN might
be the result of toxic effects of cholestasis and be in part responsible for the
impairment of renal function
Cholemic Nephropathy Causes Acute Kidney Injury and Is Accompanied by Loss of Aquaporin 2 in Collecting Ducts
Impairment of renal function often occurs in patients with liver disease. Hepatorenal
syndrome is a significant cause of acute kidney injury (AKI) in cirrhotic patients
(HRS-AKI, type 1). Causes of non-HRS AKI include cholemic nephropathy (CN), a
disease that is characterized by intratubular bile casts and tubular injury. As data on
patients with CN is mostly obtained from case reports or autopsy studies, we aimed
to investigate the frequency and clinical course of CN. We identified 149 patients who
underwent kidney biopsy between 2000 to 2016 at the Department of
Gastroenterology, Hepatology and Endocrinology. Of these, 79 had a history of liver
disease and deterioration of renal function. When applying recent EASL criteria 45 of
the 79 patients (57%) presented with AKI, whereas 34 patients (43%) had chronic
kidney disease (CKD) (43%). Renal biopsy revealed the diagnosis of CN in 8 of the
45 patients with AKI (17.8%), whereas none of the patients with CKD was diagnosed
with CN. Univariate analysis identified serum bilirubin, alkaline phosphatase and
urinary bilirubin and urobilinogen as predictive factors for the diagnosis of CN.
Histological analysis of AKI patients with normal bilirubin, elevated bilirubin and the
diagnosis of CN revealed loss aquaporin 2 (AQP2) expression in collecting ducts in
patients with elevated bilirubin and CN. Biopsy related complications requiring
medical intervention occurred in four of 79 patients (5.1%).
In conclusion, CN is a common finding in patients with liver disease, AKI and highly
elevated bilirubin. Loss of AQP2 in AKI patients with elevated bilirubin and CN might
be the result of toxic effects of cholestasis and be in part responsible for the
impairment of renal function