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Abstract: TH-PO056

A Case of Bile Cast Nephropathy Treated with Plasma Exchange Therapy for AKI Associated with Acute Hepatitis A

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials


  • Arai, Masahiro, Tokyo Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Moriyama, Takahito, Tokyo Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Iemura, Fumika, Tokyo Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Suzuki, Rie, Tokyo Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Miyaoka, Yoshitaka, Tokyo Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Kanno, Yoshihiko, Tokyo Ika Daigaku, Shinjuku-ku, Tokyo, Japan

Group or Team Name

  • Tokyo Medical University Hospital.

Bilirubin-induced renal injury has been reported as bile cast nephropathy (BCN) or cholemic nephropathy (CN) which was a rare form of acute kidney injury (AKI) in Japanese. Although the improvement of hyperbilirubinemia is effective for renal dysfunction, the treatment strategies of blood purification therapy has not been established. Here, we report a case of bile cast nephropathy associated with acute hepatitis A in which hyperbilirubinemia was treated by plasma exchange therapy and AKI was improved.

Case Description

The patient, a 45-year-old man, was admitted to the hospital with acute hepatitis A. His transaminase and serum direct bilirubin (D-Bil) was severely increased (AST: 197 1U/L, AST: 2652 U/L, and D-BIl: 8.31 mg/dL), but serum creatinine (Cr) was normal (0.81 mg/dL). While his transaminase tended to improve with the best supportive care his D-Bil was elevated to 37.6 mg/dL, and Cr was also elevated to 4.5 mg/dL on day 30. Based on the course of the disease, the possibility of BCN was suspected, and plasma exchange therapy was administered 5 times on alternative days from day 30. On day 42, we performed a percutaneous renal biopsy, and we observed bilirubin columns in the renal tubules, and we made diagnosis as BCN. After plasma exchange therapy, his D-Bil was dramatically decreased and the renal dysfunction was recovered as serum Cr level of 1.2 mg/dL.


Despite the improvement of transaminase, the elevated D-Bil induced the renal dysfunction, and we suspected BCN as the cause of AKI and successfully treated AKI due to BCN by plasma exchange therapy. BCN is rare in Japanese, and moreover, there have been few reports of renal biopsy in surviving patients. The treatment strategies of blood purification therapy to remove bilirubin have not been established, and further study is needed.