Category Ranking
98%
Total Visits
921
Avg Visit Duration
2 minutes
Citations
20
Article Abstract
Introduction: Cholemic nephropathy is an overlooked cause of acute kidney injury (AKI) in patients with cirrhosis and high bilirubin plasma levels (usually above 20 mg/dL), due to bilirubin and bile acid deposition in the kidneys. Those deposits have been hypothesized to cause tubular injury. It has no standardized diagnostic criteria or therapeutic strategies.
Method: We present a series of 15 patients with cirrhosis, acute-on-chronic liver failure (ACLF), and severe cholemic AKI, diagnosed by microscopic urinary cast visualization after excluding and treating other causes of AKI. Bilirubin plasma removal was performed with Molecular Adsorbent Recirculating System (MARS®, n = 3) or therapeutic plasma exchange (TPE, n = 12) to treat and prevent further kidney deterioration.
Results: Kidney function improved in most of the patients; 5 patients also required transient hemodialysis, with only 1 patient evolving to end-stage chronic kidney disease needing liver-kidney transplant. Five patients underwent extended TPE sessions as a bridge to liver transplantation. Survival at 30 days and 1 year was 80% and 73%, respectively, with 10 patients undergoing transplantation along this year.
Conclusion: In this highly selected cohort of patients with cirrhosis, ACLF, and severe cholemic AKI, extracorporeal plasma removal techniques seem to improve kidney function and overall prognosis. Larger prospective and controlled studies are required to better understand this condition.
Introduction: Cholemic nephropathy is an overlooked cause of acute kidney injury (AKI) in patients with cirrhosis and high bilirubin plasma levels (usually above 20 mg/dL), due to bilirubin and bile acid deposition in the kidneys. Those deposits have been hypothesized to cause tubular injury. It has no standardized diagnostic criteria or therapeutic strategies.
Method: We present a series of 15 patients with cirrhosis, acute-on-chronic liver failure (ACLF), and severe cholemic AKI, diagnosed by microscopic urinary cast visualization after excluding and treating other causes of AKI. Bilirubin plasma removal was performed with Molecular Adsorbent Recirculating System (MARS®, n = 3) or therapeutic plasma exchange (TPE, n = 12) to treat and prevent further kidney deterioration.
Results: Kidney function improved in most of the patients; 5 patients also required transient hemodialysis, with only 1 patient evolving to end-stage chronic kidney disease needing liver-kidney transplant. Five patients underwent extended TPE sessions as a bridge to liver transplantation. Survival at 30 days and 1 year was 80% and 73%, respectively, with 10 patients undergoing transplantation along this year.
Conclusion: In this highly selected cohort of patients with cirrhosis, ACLF, and severe cholemic AKI, extracorporeal plasma removal techniques seem to improve kidney function and overall prognosis. Larger prospective and controlled studies are required to better understand this condition.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949189 | PMC |
| http://dx.doi.org/10.1159/000543619 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
The impact of metabolic dysfunction-associated steatotic liver disease (MASH) on the high risk of cardiovascular disease in CKD: interconnections and management.
Clin Kidney J
September 2025
Department of Nephrology. University Clinical Hospital, INCLIVA, Valencia. RICORS Renal Instituto de salud Carlos III, Valencia. Spain.
Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a major contributor to systemic metabolic dysfunction and is increasingly recognized as a risk enhancer for both cardiovascular disease (CVD) and chronic kidney disease (CKD). This review explores the complex interconnections between MASLD, CVD, and CKD, with emphasis on shared pathophysiological mechanisms and the clinical implications for risk assessment and management. We describe the crosstalk among the liver, heart, and kidneys, focusing on insulin resistance, chronic inflammation, and progressive fibrosis as key mediators.
View Article and Find Full Text PDFAssociation between copper exposure and renal fibrosis in patients with chronic kidney disease: evidence from Mendelian randomization and a retrospective study.
Front Public Health
September 2025
Department of Nephrology and Institute of Nephrology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Background: Chronic kidney disease (CKD), a global health challenge, is closely linked to renal fibrosis progression. Copper, an essential trace element, influences cellular functions, yet its role in CKD-related fibrosis remains unclear. This study explores the causal relationship between serum copper levels and renal fibrosis in CKD.
View Article and Find Full Text PDFLiver Transplantation Using a Whole-Liver Graft Donated from a Brain-Dead Donor Complicated with Rendu-Osler-Weber Syndrome: A Case Report.
Surg Case Rep
September 2025
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan.
Introduction: Osler-Weber-Rendu syndrome, or hereditary hemorrhagic telangiectasia (HHT), is a rare autosomal dominant genetic vascular disease characterized by arteriovenous malformations, vascular wall fragility, dilatation, and rupture of the vessels with hepatic symptoms. As HHT with hepatic symptoms is recognized as the primary etiology for liver transplantation, liver transplantation with liver grafts from donors affected by HHT is extremely rare. Herein, we report a successful liver transplantation in a patient with biliary atresia who received a whole-liver graft from a young brain-dead donor with HHT.
View Article and Find Full Text PDFEpicardial Adipose Tissue and Liver Fibrosis in Patients With Type 2 Diabetes Mellitus and Metabolic Dysfunction-Associated Liver Disease.
Rev Cardiovasc Med
August 2025
Department M3/Internal Medicine VI, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş, 540142 Târgu Mureş, Romania.
Background: Epicardial adipose tissue (EAT) is an indicator of high cardiovascular and metabolic risk. This study aimed to investigate the association between EAT thickness (EATT) and liver fibrosis and steatosis in patients with type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD).
Methods: Patients with T2DM and MASLD underwent a complex evaluation, which included clinical, laboratory, and liver and transthoracic cardiac ultrasound assessments.
Ammonia-to-Urea Ratio: A Noninvasive First-Line Tool for Detecting Clinically Significant Portal Hypertension.
JGH Open
September 2025
Department of Genomic Medicine, Division of Biochemistry, Molecular Biology, and Nutrition University Hospital of Nancy Nancy France.
Introduction: Cirrhosis progresses from compensated to decompensated phases, often marked by portal hypertension and complications like ascites, variceal hemorrhage, and hepatic encephalopathy. The ammonia-to-urea (A-to-U) ratio, reflecting urea cycle efficiency, may offer superior diagnostic performance compared to plasma ammonia levels alone. This study compared the diagnostic accuracy of the A-to-U ratio and plasma ammonia levels for identifying portal hypertension.
View Article and Find Full Text PDF