**Question:** Cholemic nephrosis seen in -

A. Hepatitis
B. Cirrhosis
C. Chronic kidney disease
D. Acute kidney injury

**Core Concept:** Cholestasis is a condition characterized by the blockage or reduced flow of bile in the liver or bile ducts, leading to impaired bile secretion and accumulation of bile pigments (bilirubin) in the liver and bloodstream. This can result in various complications, including nephrotoxicity. Cholestasis-induced nephrotoxicity is known as cholemic nephropathy or cholemic nephrosis.

**Why the Correct Answer is Right:** Cholestasis-induced nephropathy is primarily seen in conditions that lead to hepatocellular dysfunction, impairing liver function and affecting bile secretion. In this case, the correct answer is B. Cirrhosis. Cirrhosis is a chronic liver disease characterized by scarring of liver tissue, leading to impaired liver function and increased bile pigment (bilirubin) production. This increased bilirubin in the bloodstream can cause nephrotoxicity, leading to cholemic nephrosis.

**Why Each Wrong Option is Incorrect:**

A. Hepatitis: Hepatitis is an inflammation of the liver caused by various pathogens. While hepatitis can cause liver dysfunction and impaired bile secretion, it is not as strongly associated with cholemic nephrosis as cirrhosis.

C. Chronic kidney disease: Although chronic kidney disease can lead to increased bilirubin production, it is not specifically linked to cholemic nephrosis as cirrhosis is.

D. Acute kidney injury: Acute kidney injury is a temporary loss of kidney function, typically due to an insult or injury to the kidneys. Acute kidney injury is not directly related to cholemic nephrosis.

**Clinical Pearl:** Cholestasis-induced nephropathy, including cholemic nephrosis, is more strongly associated with cirrhosis due to its direct impact on liver function and bile secretion. Hepatocellular dysfunction from cirrhosis results in increased bilirubin production, which can cause nephrotoxicity and lead to cholemic nephrosis.