Topic Discussion: Cholemic Nephrosis

Bile cast nephropathy is also called cholemic nephrosis. What is that and what happens?

1. As bile passes via tubules, there is pigment nephropathy.
2. Pathology findings include: extensive acute tubular injury with bile stained tubular casts.
3. Macroscopic findings will include bile stained yellowish discoloration of the kidneys in jaundiced patients which become dark green after formalin fixation.
4. Most of the damage is distal nephron related.
5. The Hall's stain confirms bilirubin presence.
6. In one series(unpublished) from Chang A et al of liver dysfunction patients, 50% of jaundiced patients had intra renal bile casts and 12% of the autopsy cases had extensive involvement of both proximal and distal tubules. 85% of patients with hepatorenal syndrome had bile casts.  In the same series, bile casts were seen in 100% of patients with alcoholic cirrhosis.
7. Recent pathology discussion at ASN suggested that bile cast nephropathy is a more appropriate term for this entity.