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Korean J Gastroenterol  <  Volume 75(3); 2020 <  Articles

Korean J Gastroenterol 2020; 75(3): 167-171  https://doi.org/10.4166/kjg.2020.75.3.167
Liver Graft Failure and Bile Cast Nephropathy
Anna Mrzljak1 ,2, Zeljka Jurekovic1, Rafaela Novak2, Bojana Maksimovic1, Danko Mikulic3 and Danica Galesic Ljubanovic2,4
Department of Internal Medicine, Merkur University Hospital1; Department of Medicine, School of Medicine, University of Zagreb2; Department of Surgery, Merkur University Hospital3; Unit for Renal Pathology and Electron Microscopy, Department of Pathology and Cytology, Dubrava University Hospital4, Zagreb, Croatia
Correspondence to: Anna Mrzljak, Department of Internal Medicine, Merkur University Hospital, Zajceva 19, 10000 Zagreb, Croatia. Tel: +385-911976261, Fax: +385-12431390, E-mail: anna.mrzljak@mef.hr, ORCID: https://orcid.org/0000-0001-6270-2305
Received: September 23, 2019; Revised: November 25, 2019; Accepted: November 27, 2019; Published online: March 25, 2020.
© The Korean Journal of Gastroenterology. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
The consequences of graft failure after liver transplantation (LT) range far beyond the liver. The kidneys are often affected, where persistent and progressive cholestasis can result in acute kidney injury (AKI) leading to the development of bile cast nephropathy (BCN). BCN is an often unrecognized condition that is characterized by proximal tubulopathy and the formation of bile casts in the distal tubules, which is almost diagnosed exclusively on a kidney biopsy or autopsy. This condition is potentially reversible, provided the bilirubin levels can be reduced early. LT may represent a treatment option in the case of irreversible liver (or liver graft) failure, which is beneficial for both the liver and the kidney. This paper reports a case of BCN in a patient with idiopathic graft failure after LT. Despite his chronic kidney disease, liver re-transplantation led to the successful improvement of his AKI.
Keywords: Liver transplantation; Liver failure; Cholestasis; Acute kidney injury; Hyperbilirubinemia


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