Evidence map›Paper›PMID 41865060›Full record

ArticleScientific reports2026

Urine microscopy can identify cholemic nephropathy as a distinct form of kidney dysfunction in patients with acute on chronic liver failure.

Rakhi Maiwall, Ashini Kumar Hidam, Gaurav Tripathi, Archana Rastogi, Deepanshu Maheshwari, Dhananjay Kumar, Jaswinder Singh Maras, Meenu Bajpai, Samba Siva Rao Pasupulati, Anupam Kumar and 3 more

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Article in Scientific reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

13 authors.

Rakhi MaiwallDepartment of Hepatology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India. rakhi_2011@yahoo.co.in.
Ashini Kumar HidamDepartment of Biochemistry, Institute of Liver and Biliary Sciences, New Delhi, India.
Gaurav TripathiDepartment of Biochemistry, Institute of Liver and Biliary Sciences, New Delhi, India.
Archana RastogiDepartment of Biochemistry, Institute of Liver and Biliary Sciences, New Delhi, India.
Deepanshu MaheshwariDepartment of Biochemistry, Institute of Liver and Biliary Sciences, New Delhi, India.
Dhananjay KumarDepartment of Biochemistry, Institute of Liver and Biliary Sciences, New Delhi, India.
Jaswinder Singh MarasDepartment of Biochemistry, Institute of Liver and Biliary Sciences, New Delhi, India.
Meenu BajpaiDepartment of Biochemistry, Institute of Liver and Biliary Sciences, New Delhi, India.
Samba Siva Rao PasupulatiDepartment of Biochemistry, Institute of Liver and Biliary Sciences, New Delhi, India.
Anupam KumarDepartment of Biochemistry, Institute of Liver and Biliary Sciences, New Delhi, India.
Vaishnavi RathiDepartment of Hepatology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India.
Richard MoreauDepartment of Biochemistry, Institute of Liver and Biliary Sciences, New Delhi, India.
Shiv Kumar SarinDepartment of Hepatology, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India. sksarin@ilbs.in.

Funding

DST-SERB CRG/2018/003690Indian Council of Medical Research ICMR 09/7882/SP-2023
6 · The paper itself

Abstract

Cholemic nephropathy(CN) is an unrecognized cause of kidney dysfunction in patients with acute on chronic liver failure (ACLF). We aimed to evaluate whether urine microscopy(UM) could identify CN in ACLF patients and differentiate from hepatorenal syndrome (HRS) and acute tubular necrosis (ATN). Forty-five patients with ACLF with AKI stratified based on UM as HRS(bland sediment; n = 15), CN(bilirubin crystals; n = 15) and ATN (coarse granular casts; n = 15) were compared to no AKI (n = 15). ACLF patients with mean age of 44 ± 10 years, 93% males were enrolled. Patients with HRS and CN showed significantly elevated biomarkers of renal repair (EGF, Osteopontin, calbindin) and lower levels of renal injury (renin, lipocalin-2, cystatin c, alpha-1 macroglobulin, albumin, TIMP-1, IP-10 and KIM-1) compared to ATN. CN patients had significantly elevated bile acids, proinflammatory cytokines (20 out of 29) compared to other groups. Metabolomic analysis of plasma and renal tubule epithelial cells (RTEC)identified 190 (151 up- and 39 downregulated) and 196 (61 up and 135-down) differentially expressed metabolites in biopsy-proven CN compared to ATN(FC > 1.5, P < 0.05). Preservation of mitochondrial function was seen in the RTEC of CN compared to ATN. The top 5 biomarkers which predicted CN included GST-alpha, IL-15, bile acids, IL-3, and osteopontin. Clinical models including GST-alpha, IL-15, bilirubin (> 22 mg/dl) or AARC score identified CN with more than 95% accuracy. Taken together, our study shows higher bile acids, preserved renal repair and lesser tubular injury despite intense systemic inflammation with preserved metabolic adaptation of the host differentiated CN from ATN.

Indexed as

Acute Kidney InjuryAcute-On-Chronic Liver FailureKidney DiseasesAdultBiomarkersFemaleHepatorenal SyndromeHumansKidney Tubular Necrosis, AcuteKidney TubulesMaleMiddle AgedUrinary Sediment AnalysisBiomarkersAKIBile cast nephropathyCRRTHRSLactateNGALPlasma-exchange

Identifiers

PMID41865060
PMCPMC13149504

What Socratic holds

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LicenceCC BY-NC-ND
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.