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Table 1 Summary of the clinical and pathological characteristics of all biopsy proven bile cast nephropathy reported in literature since 2000

From: Bile cast nephropathy: when the kidneys turn yellow

Author Age (year)/Gender Primary disease Bilirubin level (mg/dL) Peak creatinine (mg/dl) Biopsy findings Therapies used Outcome
Bal et al. [30] NA (3 cases) Subacute hepatic failure 20 (T) _ Mesangial proliferation and thickening, basement membrane thickening, presence of hyaline, granular and bile casts _ _
Kiewe et al. [31] 40/F Hodgkin’s lymphoma 30.4 (D) 1.7 Hypertrophy of tubular epithelium
Bile casts in distal and collecting tubules
Hemodialysis Resolution of kidney injury and discontinuation of hemodialysis
Betjes et al. [32] NA (2 cases) Obstructive jaundice in patient A, autoimmune hepatitis in patient B 36.2 (T)
33.2 (T)
_ Bilirubin pigment in the tubules
Tubular cell necrosis
_ Improvement of renal function along with decrease in bilirubin level in patient A
Patient B died
Uslu et al. [33] NA (20 cases) Obstructive jaundice 10.1 (T) _ Dilatation of peritubular venules, acute tubular necrosis _ Absolute recovery of renal function in all patients after biliary drainage
De Fijjter et al. [10] 38/M EBV infection 28.5 (D) 3.25 ATN features
Abundant bile casts
Hemodialysis Resolution of infection and hyperbilirubinemia
Discontinuation of hemodialysis
Burbach et al. [15] 46/M Cholangio-carcinoma 20.9 (D) 6 Presence of tubular damage: loss of brush border, tubular necrosis
Bile casts and thrombi in proximal and distal tubules
Renal replacement therapy Patient passed away
Van Slambrouck et al. [3] NA (24 cases) Obstructive cholestasis 24.9 (T) _ Bile casts with involvement of distal nephron segments _ _
Castano et al. [19] 41/M Anabolic steroid abuse 7.9 (T) 2.9 Multiple green-brown casts in the distal tubules
Diffuse ATN with dilatation of tubular lumen, vacuolization of tubular cell cytoplasm, and apical blebbing
No hemodialysis Kidney function improved over 4 months and Cr plateaued at 1.8 mg/dL
Van der Wijngaart et al. [11] 73/M Obstructive jaundice with multiple gallstones in the common bile duct 39.6 (T) 7.35 Bile casts, reactive changes of tubular epithelial cells Hemodialysis, biliary drain Improvement of kidney function after 5 weeks
Tabatabaee et al. [34] 30/M Stanozolol abuse 28 (D) 8.7 Preserved glomeruli
Degeneration of cortical tubules
Bile casts present in some tubules
Hemodialysis Cr level decreased to 2.5 mg/dL in 2 months
  43/M Stanozolol abuse 45 (D) 5.4 ATN, bile pigment deposition Hemodialysis Cr decreased to 1.8 mg/dL at 2 months
Alkhunaizi et al. [35] 28/M Anabolic steroid abuse 29.9 (D) 2.6 Glomeruli unremarkable
Acute tubular injury with luminal ectasia
Dark green bile casts within tubular lamina
Supportive care only, no dialysis At 3 month follow up:
Serum Creatinine returned to normal at 1.1 mg/dL
Serum total bilirubin dropped to 1.8 mg/dL
Sequeira and Gu [28] 41/F Acute alcoholic hepatitis 20 (D) 9.2 Normal glomeruli
Intra-tubular bile casts shown by Hall’s Stain
Hemodialysis Urine output improved gradually, however patient continued to need dialysis for poor clearance
Kshiragar et al. [36] 55/M Colorectal cancer metastatic to liver 25 (D) 2.72 Intratubular bile casts _ _
Alalawi [12] 61/F Acute liver injury 7 (T) 7.3 Positive Fouchet stain indicating presence of Bilirubin casts 7 sessions of hemodialysis Recovered kidney function
Discharge Cr = 1.1 mg
Flores et al. [37] 31/M Anabolic steroid induced cholestasis 53 (T) 2.3 Yellow, brown intraluminal tubular casts
Flattening and simplification of the epithelial lining
5 sessions of plasmapheresis
No hemodialysis
Bilirubin level decreased
Cr level decreased and patient recovered kidney function
Alnasrallah et al. [4] 60/M Flucloxacillin induced liver injury 34 (D) 6.6 Normal Glomeruli
Positive bile stain and bile casts in tubules
No hemodialysis Bilirubin level decreased
Cr level decreased to stabilize at 1.85 mg/dL
Sens et al. [26] 37/M TCF 2 Mutation induced biliary duct dystrophy 15.2 (D) 5.8 Acute tubular injury: dilated tubules with flattened epithelium
Greenish-brown intraluminal casts
9 ECAD:1 MARS and 8 SPAD sessions
Patient underwent simultaneous liver kidney transplant
Patel et al. [2] 54/M Acute liver injury 29 (T) 5.47 Proximal and distal tubules containing bile casts Hemodialysis Patient underwent simultaneous liver and kidney transplant
Normalization of kidney and hepatic indices
Werner et al. [38] 76/M Painless jaundice due to cholangiocellular carcinoma _ _ Dilated tubules, bile casts bile duct stent, Hemodialysis Resolution of renal function after restoration of cholestasis
Mohapatra et al. [39] NA (20 cases) Severe falciparum malaria complicated with jaundice 26.5 (T) _ Numerous tubular casts, acute tubular necrosis but maintained glomerular architecture _ Recovery time of renal dysfunction 15.1 ± 6.5 days
Leclerc et al. [40] 78/M Drug-induced hepatic jaundice 30.93 (T) 7.1 Brown casts clogging the tubular lumen, brown deposits in the cytoplasm of tubular epithelial cells Hemodialysis Improvement of kidney function after normalization of bilirubin and hemodialysis
Aniort et al. [41] 61/M CBD stones induced obstructive jaundice 32.6 (T) 5.3 Bilirubin tubular casts predominated in distal tubules ERCP, cholecystectomy Kidney function fully recovered to Cr level of 0.9 mg/dL after 3 months
  1. ATN acute tubular necrosis, CBD common bile duct, Cr creatinine, D direct, EBV Epstein-Barr virus, ECAD extracorporeal albumin dialysis, ERCP endoscopic retrograde cholangiopancreatography, F female, M male, MARS molecular absorbent recirculating system, NA not available, SPAD single pass albumin dialysis, TCF 2 transcription factor 2, T total