Society of Diabetic Nephropathy Prevention Journal of Nephropathology 2251-8363 12 4 2023 09 19 Bile cast nephropathy; a neglected entity e21522 e21522 10.34172/jnp.2023.21522 EN Rodrigo Alvarez https://orcid.org/0009-0007-5020-2232 Ramin Tolouian https://orcid.org/0000-0003-2242-9310 Journal Article 10.34172/jnp.2023.21522 2023 07 13 2023 08 23 This study investigates the role of bile cast nephropathy (BCN) in acute kidney injury associated with cholestatic liver disease. Bile cast nephropathy is characterized by kidney injury due to, bile-related factors, distinct from hepatorenal syndrome (HRS) linked to hemodynamic changes in liver disease. The mechanisms of BCN include oxidative damage, tubular toxicity, and obstructive physiology. Diagnosis is typically through biopsy, although alternatives like trans-jugular biopsy are considered due to bleeding risks. Treatment targets underlying causes of hyperbilirubinemia, and extracorporeal therapies like plasmapheresis and molecular adsorbent recycling system show potential efficacy. Awareness and further research on noninvasive diagnostic methods for BCN are recommended.