Cholemic nephropathy – Historical notes and novel perspectives

Acute kidney injury is common in patients with liver disease and associated with significant morbidity and mortality. Besides bacterial infections, fluid loss, and use of nephrotoxic drugs AKI in liver disease may be triggered by tubular toxicity of cholephiles. Cholemic nephropathy, also known as bile cast nephropathy, supposedly represents a widely underestimated but important cause of renal dysfunction in cholestasic or advanced liver diseases with jaundice. Cholemic nephropathy describes impaired renal function along with characteristic histomorphological changes consisting of intratubular cast formation and tubular epithelial cell injury directed towards distal nephron segments. The underlying pathophysiologic mechanisms are not entirely understood and clear defined diagnostic criteria are still missing.This review aims to summarize (i) the present knowledge on clinical and morphological characteristics of cholemic nephropathy, (ii) available preclinical models, (iii) potential pathomechanisms especially the potential role of bile acids, and (iv) future diagnostic and therapeutic strategies for cholemic nephropathy. This article is part of a Special Issue entitled: Cholangiocytes in Health and Disease edited by Jesus Banales, Marco Marzioni, Nicholas LaRusso and Peter Jansen.     

以病例为基础的讨论式教学模式在临床教学中的应用

目的:探讨以病例为基础讨论式学习(case-based discussion and learning,CBDL)在临床教学中的应用效果。方法:将40位临床医学本科专业学生随机分为两组,其中20人采用CBDL教学,20人采用传统教学,并且通过理论基础考试和临床技能考试的形式评价学生的学习效果,通过问卷的形式调查学生对教学方法的满意度。结果:CBDL教学组的理论考试、临床技能考试及总成绩得分均较传统教学组明显提高(P0.01),CBDL教学组学生对教学的满意度分别为:教学方法 100%,教学效果90%,小组功能95%,教师评价95%。结论:CBDL教学法较传统教学方法更能提高学生的基础和临床能力,为临床工作中独立解决问题打下了基础。