Bile cast nephropathy (cholemic nephropathy) associated with hepatitis A-induced acute liver failure and haemolysis in a patient with glucose-6-phosphate dehydrogenase deficiency
Introduction: The hepatitis A virus (HAV) is a common cause of acute hepatitis, while glucose-6-phosphate dehydrogenase (G6PD) deficiency is a widespread enzyme disorder that predisposes individuals to haemolysis and hyperbilirubinemia. We report a case of a G6PD-deficient patient with hepatitis A-i...
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SMC MEDIA SRL
2025-01-01
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| Series: | European Journal of Case Reports in Internal Medicine |
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| Online Access: | https://www.ejcrim.com/index.php/EJCRIM/article/view/5064 |
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| author | Ali Hamdan Johny Salem Karam Karam Maria Ziadeh Pierre Hani |
| author_facet | Ali Hamdan Johny Salem Karam Karam Maria Ziadeh Pierre Hani |
| author_sort | Ali Hamdan |
| collection | DOAJ |
| description | Introduction: The hepatitis A virus (HAV) is a common cause of acute hepatitis, while glucose-6-phosphate dehydrogenase (G6PD) deficiency is a widespread enzyme disorder that predisposes individuals to haemolysis and hyperbilirubinemia. We report a case of a G6PD-deficient patient with hepatitis A-induced acute renal failure (ARF), highlighting the role of plasmapheresis and haemodialysis in management.
Case description: A 40-year-old male with G6PD deficiency and hypertension was transferred for further care after presenting with fever, diarrhoea and jaundice. Laboratory results showed severe haemolysis and elevated bilirubin (70 µmol/l); hepatitis A serology was positive. The patient developed acute liver failure and ARF, with creatinine reaching 7.3 mg/dl. Plasmapheresis and haemodialysis were initiated, leading to stabilisation of renal function and a significant decrease in bilirubin by six weeks post-discharge.
Discussion: G6PD deficiency increases the risk of haemolysis, especially during infections such as hepatitis A. This can lead to severe hyperbilirubinemia and complications including bile cast nephropathy. In this case, plasmapheresis effectively reduced bilirubin and inflammatory mediators, while haemodialysis addressed renal dysfunction. Together, these therapies were crucial in stabilising renal function.
Conclusion: Bile cast nephropathy is an important cause of kidney injury in severe hyperbilirubinemia. This case highlights the effectiveness of plasmapheresis and haemodialysis in managing the condition and supporting renal recovery, especially in the absence of established treatment guidelines. |
| format | Article |
| id | doaj-art-8f41019ade4946caa4c89d980a67f83f |
| institution | Kabale University |
| issn | 2284-2594 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | SMC MEDIA SRL |
| record_format | Article |
| series | European Journal of Case Reports in Internal Medicine |
| spelling | doaj-art-8f41019ade4946caa4c89d980a67f83f2025-02-04T13:37:20ZengSMC MEDIA SRLEuropean Journal of Case Reports in Internal Medicine2284-25942025-01-0110.12890/2025_0050644599Bile cast nephropathy (cholemic nephropathy) associated with hepatitis A-induced acute liver failure and haemolysis in a patient with glucose-6-phosphate dehydrogenase deficiencyAli Hamdan0Johny Salem1Karam Karam2Maria Ziadeh3Pierre Hani4Department of Internal Medicine, Faculty of Medicine, University of Balamand, Dekwaneh-Beirut, LebanonDepartment of Gastroenterology, Faculty of Medicine, University of Balamand, Dekwaneh-Beirut, LebanonDepartment of Gastroenterology, Faculty of Medicine, University of Balamand, Dekwaneh-Beirut, LebanonDepartment of Internal Medicine, Faculty of Medicine, University of Balamand, Dekwaneh-Beirut, LebanonDepartment of Gastroenterology, Faculty of Medicine, University of Balamand, Dekwaneh-Beirut, LebanonIntroduction: The hepatitis A virus (HAV) is a common cause of acute hepatitis, while glucose-6-phosphate dehydrogenase (G6PD) deficiency is a widespread enzyme disorder that predisposes individuals to haemolysis and hyperbilirubinemia. We report a case of a G6PD-deficient patient with hepatitis A-induced acute renal failure (ARF), highlighting the role of plasmapheresis and haemodialysis in management. Case description: A 40-year-old male with G6PD deficiency and hypertension was transferred for further care after presenting with fever, diarrhoea and jaundice. Laboratory results showed severe haemolysis and elevated bilirubin (70 µmol/l); hepatitis A serology was positive. The patient developed acute liver failure and ARF, with creatinine reaching 7.3 mg/dl. Plasmapheresis and haemodialysis were initiated, leading to stabilisation of renal function and a significant decrease in bilirubin by six weeks post-discharge. Discussion: G6PD deficiency increases the risk of haemolysis, especially during infections such as hepatitis A. This can lead to severe hyperbilirubinemia and complications including bile cast nephropathy. In this case, plasmapheresis effectively reduced bilirubin and inflammatory mediators, while haemodialysis addressed renal dysfunction. Together, these therapies were crucial in stabilising renal function. Conclusion: Bile cast nephropathy is an important cause of kidney injury in severe hyperbilirubinemia. This case highlights the effectiveness of plasmapheresis and haemodialysis in managing the condition and supporting renal recovery, especially in the absence of established treatment guidelines.https://www.ejcrim.com/index.php/EJCRIM/article/view/5064haemolysisrenal failurehepatitis aglucose-6-phosphate dehydrogenase deficiencybile cast nephropathy |
| spellingShingle | Ali Hamdan Johny Salem Karam Karam Maria Ziadeh Pierre Hani Bile cast nephropathy (cholemic nephropathy) associated with hepatitis A-induced acute liver failure and haemolysis in a patient with glucose-6-phosphate dehydrogenase deficiency European Journal of Case Reports in Internal Medicine haemolysis renal failure hepatitis a glucose-6-phosphate dehydrogenase deficiency bile cast nephropathy |
| title | Bile cast nephropathy (cholemic nephropathy) associated with hepatitis A-induced acute liver failure and haemolysis in a patient with glucose-6-phosphate dehydrogenase deficiency |
| title_full | Bile cast nephropathy (cholemic nephropathy) associated with hepatitis A-induced acute liver failure and haemolysis in a patient with glucose-6-phosphate dehydrogenase deficiency |
| title_fullStr | Bile cast nephropathy (cholemic nephropathy) associated with hepatitis A-induced acute liver failure and haemolysis in a patient with glucose-6-phosphate dehydrogenase deficiency |
| title_full_unstemmed | Bile cast nephropathy (cholemic nephropathy) associated with hepatitis A-induced acute liver failure and haemolysis in a patient with glucose-6-phosphate dehydrogenase deficiency |
| title_short | Bile cast nephropathy (cholemic nephropathy) associated with hepatitis A-induced acute liver failure and haemolysis in a patient with glucose-6-phosphate dehydrogenase deficiency |
| title_sort | bile cast nephropathy cholemic nephropathy associated with hepatitis a induced acute liver failure and haemolysis in a patient with glucose 6 phosphate dehydrogenase deficiency |
| topic | haemolysis renal failure hepatitis a glucose-6-phosphate dehydrogenase deficiency bile cast nephropathy |
| url | https://www.ejcrim.com/index.php/EJCRIM/article/view/5064 |
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