Patients admitted to the intensive care unit are prone to various complications, one of which is acute kidney injury (AKI).

The etiology of acute kidney injury can be multifactorial. Among the various causes, sepsis remains the most prevalent. Cholemic nephropathy (CN) is a rare cause of AKI.

Patients with CN usually present with elevated total bilirubin levels of greater than 20 mg/dl. However, CN has been reported in patients with total bilirubin levels of less than 20 mg/dL.

These patients were found to have chronic elevations of bilirubin due to chronic liver disease rather than an acute rise in bilirubin levels.

In this case series, we present two cases of patients with chronic liver disease who were admitted to the intensive care unit and were found to have AKI with elevated total bilirubin levels over 15 mg/dl.

The occurrence of acute kidney injury (AKI) is prevalent in patients admitted to the intensive care unit (ICU), leading to a complex hospital course and adverse outcomes.

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