Selective Bilirubin Removal as Treatment of Jaundice-Related Kidney Injury

Abstract

Severe hyperbilirubinemia is often associated with acute kidney injury (AKT). Considering the potential renal toxicity of bilirubin, it is possible that bilirubin removal per se could represent a way to improve renal function in patients experiencing jaundice-related AKI. Here we present the case of a 47-year-old male patient, who was admitted due to severe jaundice and ascites. The patient presented a history of idiopathic myelofibrosis, associated with liver disease with stable bilirubin values of about 4 mg/dL. At admission, blood tests showed plasma bilirubin of 45 mg/dL, normal liver enzymes and AKI (creatinine 2.1 mg/dL vs a previous value of 0.7 mg/dL). Instrumental examinations and liver biopsy showed a picture of diffuse inflammatory cholangitis. During hospitalization, bilirubin levels further raised (up to 59.7 mg/dL) and, simultaneously, kidney function declined. We excluded functional causes of renal failure and hepatorenal syndrome and thus, suspecting a bilirubin-associated nephrotoxicity, we decided to treat the patient with plasma adsorption perfusion (PAP), a technique based on plasma adsorption by a bilirubin-specific adsorbent. After the treatment plasma bilirubin, as well as creatinine serum levels, progressively decreased. Unfortunately, about 10 days after the beginning of PAP the patient died of septic shock. This case represents an additional proof of the potential nephrotoxicity of bilirubin, suggesting that PAP could be a valuable therapeutic option in patients with jaundice-related AKI.