Severe AKI in a Patient With G6PD Deficiency and Acute Hepatitis A Infection
Bibliographic record
Abstract
Introduction: Hepatitis A virus (HAV) is a vaccine-preventable infection that classically causes mild illness. Less than 1% of patients with acute HAV develop fulminant liver failure, and those with comorbidities are at increased risk. Case Description: A 25-year-old male presented to a community hospital with a 1-week history of fevers, night sweats, 4kg weight loss, and dark urine. Past medical history included sickle cell trait and he was not taking any medications. He returned from a 1-month trip to India 5-days prior to symptom onset. On presentation, he was afebrile and skin was jaundiced with icteric sclera. Abdominal exam showed palpable hepatomegaly. Bloodwork revealed hemoglobin 70g/L, WBC 84x109/L (5x109/L blasts and significant neutrophilia), creatinine 267μmol/L, lactate 5.9mmol/L, ALT 3,538, ALP 99, total bilirubin 784, LDH 10,000U/L, and undetectable haptoglobin. Given the blasts noted on peripheral smear, the patient was suspected to have acute leukemia, and an infectious and autoimmune work up was also sent. He was transferred to our hospital for management. Repeat peripheral blood film revealed spherocytes without increased blasts, and flow cytometry was consistent with a leukemoid reaction. Coomb's test was negative. The patient had rapid clinical deterioration requiring hemodynamic support in the ICU. He developed oligoanuric acute kidney injury (AKI) and renal replacement therapy was initiated. Urinalysis at that time showed bile pigmented casts and no other microscopic signs of glomerular injury. A diagnostic work up revealed hepatitis A IgM antibodies and a positive glucose-6-phosphate dehydrogenase (G6PD) deficiency screen. The patient was treated supportively and had dramatic clinical improvement with complete recovery in hepatic and renal function over the next weeks. Discussion: The presentation of severe AKI, hyperbilirubinemia, and bile casts was highly suggestive of bile cast nephropathy, an uncommon cause of acute tubular necrosis. The patient's enzymopathy and acute HAV resulted in fulminant liver failure and severe oxidative hemolysis, leading to direct nephrotoxicity and renal tubular ischemia from systemic hypoperfusion. Although rare, clinicians should recognize bile cast nephropathy as an important mechanism of AKI. Prompt recognition allows for early identification of the cause of liver dysfunction and prevention of further renal injury.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".