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Cholemic Nephropathy Reloaded

Peter Fickert1, Alexander R Rosenkranz2

  • 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.

Seminars in Liver Disease
|October 19, 2019
PubMed

Insights

Cholemic nephropathy (CN) is an underappreciated cause of acute kidney injury (AKI) in patients with liver disease and jaundice. Further research is needed to define diagnostic criteria and understand its mechanisms.

Area of Science:

  • Nephrology
  • Hepatology
  • Pathology

Background:

  • Acute kidney injury (AKI) is a serious complication in patients with liver disease and jaundice.
  • Cholemic nephropathy (CN) is a significant, yet underestimated, cause of AKI in advanced liver disease with jaundice.
  • CN involves impaired renal function and histomorphological changes, including cast formation and tubular injury in distal nephron segments.

Purpose of the Study:

  • To summarize current knowledge on the clinical and morphological characteristics of CN.
  • To discuss potential pathomechanisms underlying CN.
  • To identify key questions for future research strategies concerning CN.

Main Methods:

  • Literature review and synthesis of existing data on cholemic nephropathy.
  • Analysis of clinical presentations and histopathological findings in CN.
  • Discussion of pathophysiological pathways involving biliary constituents in renal injury.

Main Results:

  • CN is characterized by specific renal functional impairments and histopathological changes.
  • Biliary constituents, such as bilirubin and bile acids, are implicated in tubular injury and cast formation during cholestasis.
  • Current understanding of CN's pathophysiology and diagnostic criteria requires further development.

Conclusions:

  • Cholemic nephropathy is an important cause of AKI in jaundiced liver disease patients.
  • Elucidation of CN's mechanisms and establishment of clear diagnostic criteria are crucial.
  • Further research is essential to advance the understanding and management of CN.

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