Bile cast nephropathy: A systematic review of case reports and case series

Table 2 Summary of the clinical characteristics, risk factors, treatment modalities, and outcomes of patients with bile cast nephropathy (derived from the 79 case reports)

	Number of evaluable patients	mean ± SD or n (%)	Range
Demographic variables
Age, years	79	48 ± 15	25-87
Male gender	79	66 (83.5)
White race	9	6 (66.7)
Liver-related parameters
Cause of liver disease or cholestasis	79
Drug-induced	79	24 (30.4)
Infection-related	79	15 (18.9)
Benign obstructive cholestasis	79	9 (11.4)
Alcohol-related	79	10 (12.7)
Malignant obstructive cholestasis	79	11 (13.9)
Other	79	10 (12.7)
Total bilirubin, mg/dL
Initial	77	27.1 ± 13.2	4.7-53.0
Peak	49	36.0 ± 15.4	7.3-102.0
Indirect bilirubin, mg/dL
Initial	44	8.5 ± 6.2	1.1-22.7
Albumin, gm/dL	33	2.9 ± 0.7	1.6-4.7
ALT, U/L	61	705 ± 1337	20-5592
AST, U/L	61	619 ± 1184	21-6205
ALP, U/L	52	404 ± 358	40-1419
PT, seconds	18	24 ± 23	10-75
INR	33	1.9 ± 1.1	1.0-6.0
Kidney-related parameters
AKI	79	70 (88.6)
Preexisting CKD	76	9 (11.8)
Acute on CKD	76	9 (11.8)
Serum creatinine, mg/dL
Baseline	26	1.1 ± 0.4	0.6-2.1
Initial	75	3.9 ± 3.2	0.6-14.3
Peak	49	5.9 ± 2.9	1.6-14.5
End-of-follow-up	50	2.1 ± 1.7	0.8-8.0
Dipstick urinalysis findings
Blood	36	15 (41.7)
Protein	39	22 (56.4)
Bilirubin	26	17 (65.4)
Urobilinogen	21	11 (52.4)
Urine sediment findings
Bilirubin/pigmented casts	49	15 (30.6)
Granular casts	49	7 (14.3)
Bilirubin and granular casts	49	4 (8.2)
Other casts	49	7 (14.3)
No casts	49	16 (32.7)
Random urine sodium, mEq/L	12	41 ± 17	15-69
Fractional excretion of sodium, %	4	1.4 ± 1.1	0.1-2.7
Histopathological ascertainment
Kidney biopsy	79	52 (65.8)
Kidney autopsy	79	4 (5.1)
None	79	23 (29.1)
Histopathological findings	56
Bile/bilirubin/green casts or green on autopsy	56	46 (82.1)
Other casts	56	7 (12.5)
Absence of casts	56	3 (5.4)
Sonographic urinary obstruction	31	1 (3.2)
Treatment modalities
Corticosteroids	79	10 (12.7)
Intravenous albumin	27	5 (18.5)
Plasmapheresis	27	11 (40.7)
Dialysis	77	39 (50.6)
Liver dialysis	27	3 (11.1)
Clinical outcomes
Duration of follow-up, months	55	4.0 ± 5.7	0.0-36.0
Liver transplantation	27	5 (18.5)
Liver and kidney transplantation	79	2 (2.5)
Kidney function
Full recovery	73	30 (41.1)
Partial recovery	73	29 (39.7)
Dialysis dependence	73	6 (8.2)
Death	76	11 (14.5)

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; PT: Prothrombin time; INR: International normalized ratio; AKI: Acute kidney injury; CKD: Chronic kidney disease.