Bile Cast Nephropathy in a Child with Acute Viral Hepatitis A: A Case Report

Acute viral hepatitis A-induced kidney injury and bile cast nephropathy are rarely reported in children. Bile cast nephropathy after viral hepatitis A infection is not a devastating condition, but when developed, it usually needs kidney replacement therapy. Bile cast nephropathy, traditionally known as cholemic nephrosis, is a unique form of kidney injury occurring in patients with hepatic failure resulting from tubular obstruction by bile casts and direct bile acid injury to tubular epithelial cells and its risk increases as serum bilirubin rises above 20 mg/dL. In this study, we report the clinical course of a young boy who developed acute viral hepatitis A infection with severe liver dysfunction and thereafter acute kidney injury which lasted for 4 weeks. Kidney biopsy showed deposition of greenish brown pigment casts in tubular lumen suggestive of bile cast nephropathy. He required hemodialysis for a week, and later on, urine output was established with subsequent normalization of kidney and hepatic functions at 6 weeks.