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Dang J, Chevalier K, Letavernier E, Tissandier C, Mouawad S, Debray D, Obadia M, Poujois A. Kidney involvement in Wilson's disease: a review of the literature. Clin Kidney J 2024; 17:sfae058. [PMID: 38660122 PMCID: PMC11040517 DOI: 10.1093/ckj/sfae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Indexed: 04/26/2024] Open
Abstract
Wilson's disease (WD) is a rare inherited disease due to the mutation of the ATP7B gene, resulting in impaired hepatic copper excretion and its pathological accumulation in various organs such as the liver, the nervous system, or the kidneys. Whereas liver failure and neuropsychiatric disorders are the most common features, less is known about the renal complications. We conducted a review of the literature to define the characteristics and pathophysiology of kidney involvement during WD. This review shed light on strong evidence for direct copper toxicity to renal tubular cells. Excessive tubular copper accumulation might present with various degrees of tubular dysfunction, ranging from mild hydroelectrolytic and acid-base disorders to complete Fanconi syndrome. Proximal and distal renal tubular acidosis also favors development of nephrolithiasis, nephrocalcinosis, and bone metabolism abnormalities. Indirect complications might involve renal hypoperfusion as occurs in hepatorenal or cardiorenal syndrome, but also tubular casts' formation during acute hemolysis, rhabdomyolysis, or bile cast nephropathy. Acute kidney failure is not uncommon in severe WD patients, and independently increases mortality. Finally, specific and long-term therapy by D-penicillamin, one of the most efficient drugs in WD, can cause glomerular injuries, such as membranous nephropathy, minimal-change disease, and, rarely, severe glomerulonephritis. Altogether, our study supports the need for interdisciplinary evaluation of WD patients involving nephrologists, with regular monitoring of tubular and glomerular functions, to provide adequate prevention of renal and bone involvement.
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Affiliation(s)
- Julien Dang
- Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Hôpital de Bicêtre, Service de Néphrologie et Transplantation, Le Kremlin-Bicêtre, France
- Centre de Compétence Maladies Rares «Syndrome Néphrotique Idiopathique», Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Kevin Chevalier
- Hôpital Fondation Rothschild, Service de Neurologie, Paris, France
- Centre de Référence de la Maladie de Wilson et autres Maladies Rares Liées au Cuivre, Paris, France
| | - Emmanuel Letavernier
- AP-HP, Hôpital Tenon, Service des Explorations Fonctionnelles Multidisciplinaires, Paris, France
| | - Come Tissandier
- Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Hôpital de Bicêtre, Service de Néphrologie et Transplantation, Le Kremlin-Bicêtre, France
- Centre de Compétence Maladies Rares «Syndrome Néphrotique Idiopathique», Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Sarah Mouawad
- Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Hôpital de Bicêtre, Service de Néphrologie et Transplantation, Le Kremlin-Bicêtre, France
- Centre de Compétence Maladies Rares «Syndrome Néphrotique Idiopathique», Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Dominique Debray
- Hôpital Fondation Rothschild, Service de Neurologie, Paris, France
- Centre de Référence de la Maladie de Wilson et autres Maladies Rares Liées au Cuivre, Paris, France
| | - Mickaël Obadia
- Hôpital Fondation Rothschild, Service de Neurologie, Paris, France
- Centre de Référence de la Maladie de Wilson et autres Maladies Rares Liées au Cuivre, Paris, France
| | - Aurélia Poujois
- Hôpital Fondation Rothschild, Service de Neurologie, Paris, France
- Centre de Référence de la Maladie de Wilson et autres Maladies Rares Liées au Cuivre, Paris, France
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Pinter K, Rosenkranz A. Cholemic Nephropathy: Role in Acute Kidney Injury in Cholestasis and Cirrhosis. ADVANCES IN KIDNEY DISEASE AND HEALTH 2024; 31:111-126. [PMID: 38649215 DOI: 10.1053/j.akdh.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 06/28/2023] [Accepted: 07/12/2023] [Indexed: 04/25/2024]
Abstract
The concept of structural kidney damage and renal dysfunction as a result of jaundice attracted attention in the medical community in the early and mid-20th century. The postulated doctrine of the time was that the excretion of elevated concentrations of bile results in bile-stained casts occupying collecting and distal convoluted tubules, degeneration of tubular epithelium, and decreased renal function. Compared to the hepatorenal syndrome, the poster child of hepatology and nephrology collaboration, the notion of structural kidney damage and renal dysfunction as a result of cholemia lost its traction and has almost disappeared from modern textbooks. Today, cholemic nephropathy is experiencing a renaissance, with multiple case reports and case series of jaundiced patients with kidney dysfunction and evidence of bile acid casts upon histologic examination. Published cases include acute hepatitis, chronic liver injury, cirrhosis, and obstructive etiologies. Diagnosis of cholemic nephropathy is based on histological examination, typically showing intraluminal bile casts predominantly located in the distal tubules. In common bile duct-ligated mice, the histomorphological and functional alterations of cholemic nephropathy mimic those seen in humans. Some argue against the concept of cholemic nephropathy and postulate that bile casts are a secondary phenomenon. What we need are carefully designed trials to establish diagnostic criteria and subsequently translate this knowledge into evidence-based therapies.
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Somagutta MR, Jain MS, Pormento MKL, Pendyala SK, Bathula NR, Jarapala N, Mahadevaiah A, Sasidharan N, Gad MA, Mahmutaj G, Hange N. Bile Cast Nephropathy: A Comprehensive Review. Cureus 2022; 14:e23606. [PMID: 35505725 PMCID: PMC9053373 DOI: 10.7759/cureus.23606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/29/2022] [Indexed: 11/14/2022] Open
Abstract
Bile cast nephropathy (BCN) or cholemic nephropathy (CN) is an acute renal dysfunction, including acute kidney injury (AKI) in the setting of liver injury. It is a common phenomenon in patients with liver disease and is associated with significant morbidity and mortality. CN is characterized by hemodynamic changes in the liver, kidney, systemic circulation, intratubular cast formation, and tubular epithelial cell injury. CN has been overlooked as a differential diagnosis in chronic liver disease patients due to more importance to hepatic injury. However, frequent and considerable reporting of case reports recently has further investigated this topic in the last two decades. This review determines the evidence behind the potential role of bile acids and bilirubin in acute renal dysfunction in liver injury, summarizing the implied pathophysiology risk factors, and incorporating the therapeutic mechanisms and outcomes.
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Zhao X, Huang R, Wong P, Fiset PO, Deschênes M. Renal tubular injury in hyperbilirubinemia: Bile cast nephropathy. CANADIAN LIVER JOURNAL 2021; 4:332-337. [DOI: 10.3138/canlivj-2020-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/26/2020] [Indexed: 11/20/2022]
Abstract
The toxic renal accumulation of bile pigment sparked clinical intrigue almost a century ago. More recently, however, the identification of bile casts within renal tubules in patients with liver dysfunction has been largely overlooked. We have reviewed the literature, including natural history, pathophysiology, and potential treatment of bile cast nephropathy (BCN). We report two cases of acute kidney injury (AKI) associated with acute-on-chronic liver failure in which prolonged hyperbilirubinemia and bile cast identification on renal biopsy evoked the diagnosis of BCN.
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Affiliation(s)
- Xun Zhao
- Department of Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montréal, Québec, Canada
| | - Ruiyao Huang
- Department of Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montréal, Québec, Canada
| | - Philip Wong
- Department of Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montréal, Québec, Canada
| | - Pierre-Oliver Fiset
- Department of Pathology, Royal Victoria Hospital, McGill University Health Centre, Montréal, Québec, Canada
| | - Marc Deschênes
- Department of Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montréal, Québec, Canada
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Ommati MM, Farshad O, Azarpira N, Ghazanfari E, Niknahad H, Heidari R. Silymarin mitigates bile duct obstruction-induced cholemic nephropathy. Naunyn Schmiedebergs Arch Pharmacol 2021; 394:1301-1314. [PMID: 33538845 DOI: 10.1007/s00210-020-02040-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/09/2020] [Indexed: 12/14/2022]
Abstract
Bile duct obstruction or cholestasis can occur by several diseases or xenobiotics. Cholestasis and the accumulation of the bile constituents in the liver primarily damage this organ. On the other hand, extrahepatic organs are also affected by cholestasis. The kidney is the most affected tissue during cholestatic liver injury. Cholestasis-associated renal injury is known as cholemic nephropathy (CN). Several lines of evidence specify the involvement of oxidative stress and mitochondrial impairment in the pathogenesis of CN. The current study aimed to assess the role of silymarin as a potent antioxidant on CN-induced oxidative stress and mitochondrial dysfunction in the kidney. Bile duct ligated (BDL) rats were treated with silymarin (10 and 100 mg/kg, oral) for seven consecutive days. A significant increase in reactive oxygen species (ROS), lipid peroxidation, protein carbonylation, and oxidized glutathione (GSSG) levels were evident in the kidney of BDL animals. Moreover, reduced glutathione (GSH) content and total antioxidant capacity were significantly decreased in the kidney of cholestatic rats. Mitochondrial depolarization, decreased mitochondrial dehydrogenases activity, mitochondrial permeabilization, and depleted ATP stores were detected in the kidney mitochondria isolated from BDL animals. Kidney histopathological alterations, as well as serum and urine levels of renal injury biomarkers, were also significantly different in the BDL group. It was found that silymarin treatment significantly ameliorated CN-induced renal injury. The antioxidant effects of silymarin and its positive impact on mitochondrial indices seem to play a significant role in its renoprotective effects during cholestasis.
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Affiliation(s)
- Mohammad Mehdi Ommati
- College of Life Sciences, Shanxi Agricultural University, Taigu, 030801, Shanxi, China
| | - Omid Farshad
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Pharmacology and Toxicology, School of Pharmacy, Shiraz University of Medical Sciences, P.O. Box 158371345, Roknabad, Karafarin St., Shiraz, Fars, Iran
| | - Negar Azarpira
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elmira Ghazanfari
- Department of Pharmacology and Toxicology, School of Pharmacy, Shiraz University of Medical Sciences, P.O. Box 158371345, Roknabad, Karafarin St., Shiraz, Fars, Iran
| | - Hossein Niknahad
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. .,Department of Pharmacology and Toxicology, School of Pharmacy, Shiraz University of Medical Sciences, P.O. Box 158371345, Roknabad, Karafarin St., Shiraz, Fars, Iran.
| | - Reza Heidari
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Jansi Prema KS, Kurien AA. Etiological Spectrum and Histopathological Diagnosis of Rhabdomyolysis Associated Myoglobin Cast Nephropathy in South India. Indian J Nephrol 2021; 31:22-26. [PMID: 33994683 PMCID: PMC8101665 DOI: 10.4103/ijn.ijn_383_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/14/2020] [Accepted: 04/24/2020] [Indexed: 11/21/2022] Open
Abstract
Background and Aims: Rhabdomyolysis occurs due to injury to skeletal muscle fibers and the release of muscle constituents into the circulation. Myoglobin cast nephropathy leading to acute kidney injury is one of the most severe complications of rhabdomyolysis. This is a retrospective study which aims to analyse the clinicopathological features of myoglobin cast nephropathy. Methods: A total of 57 cases of myoglobin cast nephropathy were identified after performing immunohistochemical staining for myoglobin on all renal biopsies with pigment casts. The clinical, laboratory data, histopathological findings and clinical outcome of these cases were evaluated. Results: The mean patient age was 34.47 years (range 17-77) and the male to female ratio was 6.1:1. All patients presented with acute kidney injury with mean serum creatinine of 8.4 mg/dl (range: 1.7 to 20.8 mg/dl). Rhabdomyolysis was clinically suspected only in 31 patients. Along with myoglobin casts, acute tubular injury was present in all the biopsies. The most frequent conditions associated with myoglobin cast nephropathy in our study were snake envenomation and unaccustomed physical activities. A few activities that caused rhabdomyolysis in our patients were unique to India. Conclusion: Clinicians should be aware of the wide spectrum of causes for rhabdomyolysis. The classical clinical and laboratory findings of rhabdomyolysis may not be present in many of the patients. The pathologist must have a high index of suspicion, and immunohistochemical stain should be used to confirm the diagnosis.
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Affiliation(s)
- K S Jansi Prema
- Renopath, Center for Renal and Urological Pathology, Chennai, Tamil Nadu, India
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Jamshaid MB, Iqbal P, Shahzad A, Yousaf Z, Mohamedali M. Acute Renal Failure Due to Bile Cast Nephropathy: An Overlooked Cause of Kidney Injury. Cureus 2020; 12:e9724. [PMID: 32944443 PMCID: PMC7489443 DOI: 10.7759/cureus.9724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
| | - Phool Iqbal
- Internal Medicine, Hamad General Hospital, Doha, QAT
| | | | - Zohaib Yousaf
- Internal Medicine, Hamad Medical Corporation, Doha, QAT.,Clinical Research, Dresden International University, Dresden, DEU
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Mrzljak A, Jurekovic Z, Novak R, Maksimovic B, Mikulic D, Ljubanovic DG. Liver Graft Failure and Bile Cast Nephropathy. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2020; 75:167-171. [PMID: 32209806 DOI: 10.4166/kjg.2020.75.3.167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 02/05/2023]
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.
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Affiliation(s)
- Anna Mrzljak
- Department of Internal Medicine, Merkur University Hospital, Zagreb, Croatia
- Department of Medicine, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Zeljka Jurekovic
- Department of Internal Medicine, Merkur University Hospital, Zagreb, Croatia
| | - Rafaela Novak
- Department of Medicine, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Bojana Maksimovic
- Department of Internal Medicine, Merkur University Hospital, Zagreb, Croatia
| | - Danko Mikulic
- Department of Surgery, Merkur University Hospital, Zagreb, Croatia
| | - Danica Galesic Ljubanovic
- Department of Medicine, School of Medicine, University of Zagreb, Zagreb, Croatia
- Unit for Renal Pathology and Electron Microscopy, Department of Pathology and Cytology, Dubrava University Hospital, Zagreb, Croatia
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