A Case Series of Bile Cast Nephropathy-induced Rapidly Progressive Renal Failure

Abstract

Abstract A 45-year-old male presented to the hospital with symptoms of left inguinal swelling, which showed granulomatous adenitis on fine-needle aspiration cytology. He was diagnosed with tuberculous adenitis, for which he was started on antitubercular treatment. After 15 days of antitubercular treatment, the patient developed deranged renal parameters, with serum creatinine of 8.8 mg/dL while serum bilirubin rose to 7.4 mg/dL. The patient was oliguric and underwent four sessions of hemodialysis. Following this, a renal biopsy was done, which showed normal glomeruli with tubular casts that were pigmented, consistent with acute tubular injury secondary to bile cast nephropathy. The patient’s condition improved with one more session of hemodialysis and conservative management. Serum creatinine declined to 1.2 mg/dL, at the time of discharge, with normal urine output. This case illustrates features of bile cast nephropathy presenting as rapidly progressive renal failure secondary to antitubercular treatment.