P2943 - Bile Cast Nephropathy: A Systematic Review

Hind El Naamani, MD¹, Iyiad Alabdul Razzak, MD², Dimo Dimitrov, MD^1
1St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA; ²St. Elizabeth's Medical Center, Boston University School of Medicine, Brighton, MA

Introduction: Bile cast nephropathy (BCN) occurs in various forms of liver failure, with autopsy studies indicating a prevalence of up to 55%. Despite this, BCN is frequently unrecognized due to uncertainties about its clinical impact, prognostic value, and management strategies. To address this gap, we conducted a systematic review of case reports, case series, and cohort studies to examine the clinical characteristics and outcomes of patients with BCN.

Methods: We searched electronic databases for eligible studies on BCN published from January 1, 1980, to October 31, 2023. BCN diagnosis certainty was classified as possible, probable, and definite based on pre-determined criteria. Case reports and case series were included, with analyses stratified by initial total bilirubin tertiles and the cause of cholestatic liver disease (alcohol- vs. nonalcohol-related). The Mann-Whitney U test and Kruskal-Wallis test were used for continuous variables, and the Chi square test for categorical variables.

Results: 67 case reports and 6 case series, met the inclusion criteria, totaling 79 cases. Mean age was 48.3 years old, and 83.5% were men. The most common cause of cholestatic liver disease was drug-induced injury (30.4%), infection (19.0%), and alcohol use (12.7%). Mean initial total bilirubin was 30.3 mg/dL. The diagnosis of BCN was deemed definite in 65.8%, probable in 32.9%, and possible in 1.3% of patients. 40 (50.6%) patients required dialysis. Follow-up data on kidney function were available for 73 patients, with complete recovery in 30 (41.1%) patients and partial recovery in 29 (39.7%) patients. Of the remainder, 8 (11%) patients remained dialysis-dependent or underwent kidney transplantation, and 6 (8%) died. There was a nonsignificant trend towards higher initial serum creatinine in the higher total bilirubin tertile group (p=0.07). There were otherwise no significant differences in other kidney injury related markers across the total bilirubin tertile groups. Patients with alcohol-related liver disease exhibited higher initial (p=0.01) and peak (p=0.01) serum creatinine, lower serum albumin (p=0.05), and higher INR (p=0.01).

Discussion: In patients with acute kidney injury due to BCN, serum creatinine is higher in those with alcohol-related cholestatic liver disease and higher total bilirubin levels, potentially indicating bile acid-associated nephrotoxicity. Further studies are needed to explore the role of albumin dialysis in removing bilirubin and bile acids in BCN patients.


Disclosures:


Hind El Naamani, MD¹, Iyiad Alabdul Razzak, MD², Dimo Dimitrov, MD¹. P2943 - Bile Cast Nephropathy: A Systematic Review, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.