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Acute Kidney Injury in Patients Admitted to the Intensive Care Unit: A Case Report
Ayman Mohamed1, Michael Peniston2, Rabia Mahmood1
1Internal Medicine, Ascension St. John Hospital, Detroit, USA.
Cureus
|June 16, 2023
Summary
Acute kidney injury (AKI) can stem from various causes, including sepsis. This case series highlights cholemic nephropathy (CN) in patients with chronic liver disease and elevated bilirubin, a rare but significant cause of AKI.
Area of Science:
- Nephrology
- Hepatology
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) is a common complication in intensive care unit (ICU) patients.
- Sepsis is the most frequent cause of AKI, but other etiologies exist.
- Cholemic nephropathy (CN) is a rare cause of AKI, typically associated with very high total bilirubin levels (>20 mg/dL).
Observation:
- This case series presents two ICU patients with chronic liver disease.
- Both patients exhibited AKI with elevated total bilirubin levels (>15 mg/dL).
- These cases suggest CN can occur with chronic, rather than acute, bilirubin elevations.
Findings:
- Cholemic nephropathy (CN) should be considered in ICU patients with chronic liver disease and AKI, even with bilirubin levels below the traditional threshold.
- Chronic hyperbilirubinemia, secondary to liver disease, may predispose to AKI via cholemic nephropathy.
- Diagnostic criteria for CN may need re-evaluation in the context of chronic liver disease.
Implications:
- Recognizing CN in this context can lead to earlier diagnosis and management of AKI in patients with chronic liver disease.
- This expands the understanding of AKI etiologies in critically ill patients.
- Further research is warranted to elucidate the pathophysiology of CN in chronic liver disease.
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