title: Urinary bile casts in bile cast nephropathy secondary to severe falciparum malaria.
abstract: BACKGROUND
  Severe cholestatic jaundice may complicate with bile cast nephropathy (BCN) causing severe acute kidney injury (AKI). In this study, we investigate BCN in severe falciparum malaria complicated with jaundice and AKI.
  
  
  METHODS
  This prospective study was conducted in a tertiary health care institution with high prevalence of malaria. A cohort of 110 patients with falciparum malaria complicated with cerebral malaria, jaundice and AKI were enrolled. Species diagnosis was made from peripheral blood smear or rapid diagnostic test. Severe malaria was diagnosed from WHO criteria. BCN was diagnosed with the detection of bile casts in urine or in biopsy. The recovery pattern and outcome with and without BCN was assessed.
  
  
  RESULTS
  Out of 110 patients, 20 (18.2%) patients had BCN and 15 (13.6%) patients had hepato-renal syndrome. Patients with BCN had high conjugated bilirubin (26.5 ± 4.1 mg/dL), urea (75.9 ± 10.3 mg/dL) and creatinine (7.2 ± 0.8 mg/dL), longer duration of illness (6.4 ± 1.1 days), higher mortality (25.0%) and prolonged recovery time of hepatic (9.6 ± 2.4 days) and renal dysfunction (15.1 ± 6.5 days) compared with patients without BCN.
  
  
  CONCLUSIONS
  Prolonged duration of illness and increased bilirubin cause BCN among patients with severe falciparum malaria with jaundice and AKI, which is associated with high mortality and morbidity.
authors.affiliation: Department of Medicine, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha , India.
authors.forename: Manoj Kumar
authors.initials: MK
authors.lastname: Mohapatra
authors.affiliation: Department of Medicine, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha , India.
authors.forename: Ashok Kumar
authors.initials: AK
authors.lastname: Behera
authors.affiliation: Department of Medicine, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha , India.
authors.forename: Purna Chandra
authors.initials: PC
authors.lastname: Karua
authors.affiliation: Department of Medicine, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha , India.
authors.forename: Prafulla Kumar
authors.initials: PK
authors.lastname: Bariha
authors.affiliation: Department of Medicine, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha , India.
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Rath
authors.affiliation: Department of Pathology, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha , India.
authors.forename: Kailash Chandra
authors.initials: KC
authors.lastname: Aggrawal
authors.affiliation: Department of Pathology, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha , India.
authors.forename: Snigdha Rani
authors.initials: SR
authors.lastname: Nahak
authors.affiliation: Department of Pathology, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha , India.
authors.forename: Santosh Shankar
authors.initials: SS
authors.lastname: Gudaganatti
keywords: bile casts; cholemic nephrosis; hepato-renal syndrome; jaundice-related nephropathy