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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

AuthorAge (year)/GenderPrimary diseaseBilirubin level (mg/dL)Peak creatinine (mg/dl)Biopsy findingsTherapies usedOutcome
Bal et al. [30]NA (3 cases)Subacute hepatic failure20 (T)_Mesangial proliferation and thickening, basement membrane thickening, presence of hyaline, granular and bile casts__
Kiewe et al. [31]40/FHodgkin’s lymphoma30.4 (D)1.7Hypertrophy of tubular epithelium
Bile casts in distal and collecting tubules
HemodialysisResolution of kidney injury and discontinuation of hemodialysis
Betjes et al. [32]NA (2 cases)Obstructive jaundice in patient A, autoimmune hepatitis in patient B36.2 (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 jaundice10.1 (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/MEBV infection28.5 (D)3.25ATN features
Abundant bile casts
HemodialysisResolution of infection and hyperbilirubinemia
Discontinuation of hemodialysis
Burbach et al. [15]46/MCholangio-carcinoma20.9 (D)6Presence of tubular damage: loss of brush border, tubular necrosis
Bile casts and thrombi in proximal and distal tubules
Renal replacement therapyPatient passed away
Van Slambrouck et al. [3]NA (24 cases)Obstructive cholestasis24.9 (T)_Bile casts with involvement of distal nephron segments__
Castano et al. [19]41/MAnabolic steroid abuse7.9 (T)2.9Multiple green-brown casts in the distal tubules
Diffuse ATN with dilatation of tubular lumen, vacuolization of tubular cell cytoplasm, and apical blebbing
No hemodialysisKidney function improved over 4 months and Cr plateaued at 1.8 mg/dL
Van der Wijngaart et al. [11]73/MObstructive jaundice with multiple gallstones in the common bile duct39.6 (T)7.35Bile casts, reactive changes of tubular epithelial cellsHemodialysis, biliary drainImprovement of kidney function after 5 weeks
Tabatabaee et al. [34]30/MStanozolol abuse28 (D)8.7Preserved glomeruli
Degeneration of cortical tubules
Bile casts present in some tubules
HemodialysisCr level decreased to 2.5 mg/dL in 2 months
 43/MStanozolol abuse45 (D)5.4ATN, bile pigment depositionHemodialysisCr decreased to 1.8 mg/dL at 2 months
Alkhunaizi et al. [35]28/MAnabolic steroid abuse29.9 (D)2.6Glomeruli unremarkable
Acute tubular injury with luminal ectasia
Dark green bile casts within tubular lamina
Supportive care only, no dialysisAt 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/FAcute alcoholic hepatitis20 (D)9.2Normal glomeruli
Intra-tubular bile casts shown by Hall’s Stain
HemodialysisUrine output improved gradually, however patient continued to need dialysis for poor clearance
Kshiragar et al. [36]55/MColorectal cancer metastatic to liver25 (D)2.72Intratubular bile casts__
Alalawi [12]61/FAcute liver injury7 (T)7.3Positive Fouchet stain indicating presence of Bilirubin casts7 sessions of hemodialysisRecovered kidney function
Discharge Cr = 1.1 mg
Flores et al. [37]31/MAnabolic steroid induced cholestasis53 (T)2.3Yellow, 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/MFlucloxacillin induced liver injury34 (D)6.6Normal Glomeruli
Positive bile stain and bile casts in tubules
No hemodialysisBilirubin level decreased
Cr level decreased to stabilize at 1.85 mg/dL
Sens et al. [26]37/MTCF 2 Mutation induced biliary duct dystrophy15.2 (D)5.8Acute 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/MAcute liver injury29 (T)5.47Proximal and distal tubules containing bile castsHemodialysisPatient underwent simultaneous liver and kidney transplant
Normalization of kidney and hepatic indices
Werner et al. [38]76/MPainless jaundice due to cholangiocellular carcinoma__Dilated tubules, bile castsbile duct stent, HemodialysisResolution of renal function after restoration of cholestasis
Mohapatra et al. [39]NA (20 cases)Severe falciparum malaria complicated with jaundice26.5 (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/MDrug-induced hepatic jaundice30.93 (T)7.1Brown casts clogging the tubular lumen, brown deposits in the cytoplasm of tubular epithelial cellsHemodialysisImprovement of kidney function after normalization of bilirubin and hemodialysis
Aniort et al. [41]61/MCBD stones induced obstructive jaundice32.6 (T)5.3Bilirubin tubular casts predominated in distal tubulesERCP, cholecystectomyKidney 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