{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:50:02Z","timestamp":1791352202365,"version":"4.3.1"},"reference-count":12,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Autoimmune hemolytic anemia (AIHA) is an uncommon acquired disorder that can lead to life-threatening intravascular hemolysis and acute kidney injury (AKI). Hemoglobin cast nephropathy is a rare but severe complication of massive hemolysis, often underrecognized in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentations<\/jats:title>\n                    <jats:p>We describe a 57-year-old female with no prior chronic kidney disease who presented with nausea, vomiting, oliguria, edema, and rapidly progressive renal dysfunction after a presumed preceding infectious-like episode. Laboratory investigations revealed severe anemia, elevated hemolytic markers, and a positive direct antiglobulin test (DAT) for complement C3 (C3d) and negative for IgG. Renal biopsy demonstrated acute tubular injury with hemoglobin casts confirmed by immunostaining, consistent with hemoglobin cast nephropathy. The patient was treated with intermittent renal replacement therapy, intravenous methylprednisolone, and supportive care. Renal function and hemoglobin levels gradually normalized, and she remained well without relapse over 11.5 months of follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights that when acute kidney injury and hemolytic anemia occur concurrently, hemoglobin cast nephropathy should be strongly suspected. Renal biopsy is valuable when the diagnosis is uncertain. Early immunosuppressive therapy, renal replacement therapy, and supportive care can lead to favorable outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1898126","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:52:52Z","timestamp":1791348772000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Acute kidney injury due to hemoglobin cast nephropathy secondary to autoimmune hemolytic anemia: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Xiaoqian","family":"Qian","sequence":"first","affiliation":[{"name":"Renal Division, Department of Internal Medicine, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Zou","sequence":"additional","affiliation":[{"name":"Renal Division, Department of Internal Medicine, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1002\/ajh.10062","article-title":"Autoimmune hemolytic anemia","volume":"69","author":"Gehrs","year":"2002","journal-title":"Am J Hematol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1407","DOI":"10.1056\/NEJMra2033982","article-title":"Autoimmune hemolytic anemias","volume":"385","author":"Berentsen","year":"2021","journal-title":"N Engl J Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"E291","DOI":"10.1002\/ajh.26213","article-title":"Epidemiology of autoimmune hemolytic anemia: a nationwide population-based study in France","volume":"96","author":"Maquet","year":"2021","journal-title":"Am J Hematol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"4296","DOI":"10.3390\/ijms25084296","article-title":"Autoimmune hemolytic anemias: classifications, pathophysiology, diagnoses and management","volume":"25","author":"Loriamini","year":"2024","journal-title":"Int J Mol Sci"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2804","DOI":"10.1182\/blood-2014-02-522128","article-title":"Paroxysmal nocturnal hemoglobinuria","volume":"124","author":"Brodsky","year":"2014","journal-title":"Blood"},{"key":"B6","doi-asserted-by":"publisher","first-page":"497","DOI":"10.2147\/CLEP.S250250","article-title":"Increasing incidence and prevalence of acquired hemolytic anemias in Denmark, 1980\u20132016","volume":"12","author":"Hansen","year":"2020","journal-title":"Clin Epidemiol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1228142","DOI":"10.3389\/fimmu.2023.1228142","article-title":"Severe autoimmune hemolytic anemia; epidemiology, clinical management, outcomes and knowledge gaps","volume":"14","author":"Mulder","year":"2023","journal-title":"Front Immunol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"E243","DOI":"10.1002\/ajh.25212","article-title":"Predictors of refractoriness to therapy and healthcare resource utilization in 378 patients with primary autoimmune hemolytic anemia from eight Italian reference centers","volume":"93","author":"Barcellini","year":"2018","journal-title":"Am J Hematol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1400","DOI":"10.1016\/j.kint.2019.08.026","article-title":"Hemolysis-associated hemoglobin cast nephropathy results from a range of clinicopathologic disorders","volume":"96","author":"Dvanajscak","year":"2019","journal-title":"Kidney Int"},{"key":"B10","doi-asserted-by":"publisher","first-page":"46","DOI":"10.4103\/ijn.ijn_454_21","article-title":"Hemoglobin casts in kidney biopsies: etiological spectrum","volume":"33","author":"Prema","year":"2023","journal-title":"Indian J Nephrol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1053\/j.ajkd.2010.03.025","article-title":"Hemolysis and acute kidney failure","volume":"56","author":"Qian","year":"2010","journal-title":"Am J Kidney Dis"},{"key":"B12","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1681\/ASN.2006080894","article-title":"Physiology and pathophysiology of heme: implications for kidney disease","volume":"18","author":"Tracz","year":"2007","journal-title":"J Am Soc Nephrol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1898126\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:52:53Z","timestamp":1791348773000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1898126\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":12,"alternative-id":["10.3389\/fmed.2026.1898126"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1898126","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]},"article-number":"1898126"}}