SHM Converge Scientific Abstract ePoster Gallery-Drug Induced Liver Injury Causing Acute Kidney Failure From Bile Cast Nephropathy

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This case describes a 74-year-old woman with chronic myelocytic leukemia treated with nilotinib for 15 years and atorvastatin for hyperlipidemia who presented with progressive weakness, jaundice, and anuria. She had no fever, chills, or other clear trigger. On exam she was jaundiced and weak, and labs showed severe liver dysfunction with marked hyperbilirubinemia and coagulopathy, along with acute kidney injury.  <br /><br />She was admitted to the MICU, where she required emergent continuous renal replacement therapy and later intermittent hemodialysis. An extensive liver workup, including viral and autoimmune testing, was negative. Both nilotinib and atorvastatin were stopped. Kidney biopsy revealed bile cast nephropathy and widespread acute tubular necrosis. Hepatology concluded that her liver injury was most likely drug-induced, with nilotinib and possibly statin therapy as the cause. Liver biopsy was not needed because her INR improved after stopping the medications.  <br /><br />The key lesson from this case is that bile cast nephropathy should be considered in patients with acute kidney injury and severe hyperbilirubinemia, especially when acute liver failure is present. Hyperbilirubinemia can directly contribute to kidney injury and may be overlooked. This case also highlights that drug-induced liver injury can occur even after years of stable use of medications such as nilotinib and atorvastatin. Prompt recognition and discontinuation of hepatotoxic drugs are essential to prevent ongoing liver and kidney damage.  <br /><br />The patient ultimately improved enough to be discharged on regular hemodialysis to a sub-acute rehabilitation facility, with normalization of her PT/INR.

Asset Subtitle

Mark Patrick Cubillan

Meta Tag

Author List Dennis T. Roarke, Mark Patrick Cubillan, Xianghui Zou

Category Clinical Vignettes

Concept Bile Cast Nephropathy

Concept Acute Kidney Injury

Concept Hyperbilirubinemia

Concept Drug-Induced Liver Injury

Concept Acute Liver Failure

Distinguished Non-Finalist

Presenter Organization Northwell Health at Northshore and Long Island Jewish

Presenting Author Mark Patrick Cubillan

Track Adult

Keywords

bile cast nephropathy

acute kidney injury

hyperbilirubinemia

drug-induced liver injury

nilotinib

atorvastatin

acute liver failure

acute tubular necrosis

hemodialysis

chronic myelocytic leukemia

Bile Cast Nephropathy

Acute Kidney Injury

Hyperbilirubinemia

Drug-Induced Liver Injury

Acute Liver Failure