Abstract: SA-PO0330
Leucine Crystals in Advanced Liver Disease
Session Information
- AKI: Case Reports - Drug/Toxin Injury, Crystals, Obstruction, and Unusual Presentations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Rajan, Roy, Dartmouth College, Hanover, New Hampshire, United States
- Ozair, Saleha, Dartmouth College, Hanover, New Hampshire, United States
- Yanik, Andrew J., Dartmouth College, Hanover, New Hampshire, United States
- Block, Clay A., Dartmouth College, Hanover, New Hampshire, United States
Introduction
Leucine crystalluria is a rare finding typically associated with advanced hepatic dysfunction and severe metabolic derangements. Because the liver is the only organ capable of complete oxidative metabolism of leucine, hepatocellular failure results in impaired leucine degradation, systemic accumulation, and urinary supersaturation, leading to crystal formation
Case Description
A 50 year old male, recently migrated from Cuba, was admitted to the ICU with acute liver failure due to severe alcoholic hepatitis, complicated by acute kidney injury requiring continuous Veno venous hemofiltration (CVVH).Urine microscopy demonstrated both free urinary crystals and crystals embedded within urinary casts. The crystals were spherical, yellowish orange, and variable in size, with characteristic concentric “bull’s-eye” rings and internal radial striations (“tree-trunk” appearance). The crystals were non-birefringent under polarized light, consistent with leucine crystalluria.
Discussion
The presence of leucine crystals within urinary casts suggests intratubular precipitation, which may contribute to tubular injury and worsening acute kidney injury in the setting of multiorgan failure.