Amongst the given differential diagnosis for acute renal failure in liver disease is an entity termed "cholemic nephrosis." It is debatable as to whether or not this actually exists or represents part of the spectrum of hepatorenal syndrome or another unidentifiable cause of ATN.The idea here is that markedly elevated (e.g., >25 m/dL) concentrations of bilirubin, either conjugated or unconjugated, can result in acute tubular necrosis, even in the absence of apparent portal hypertension or other common causes of ATN. Individuals with this diagnosis may show bilirubin (yellowish)-pigmented granular casts.
In support of this idea, isolated rat kidney perfused with high bilirubin concentrations showed evidence of tubular toxicity.
As a 1st year renal fellow, just wanted to say thank you for blogging. Each teaching point very interesting and educational. Most the fellows in my program read your blog daily. Once again, thank you.
ReplyDeletethanks so much for your feedback, and feel welcome to add other "teaching points" you come upon during your own fellowship experience.
ReplyDelete