Bile cast nephropathy or cholemic nephrosis has been largely forgotten in the modern medical literature, a phenomenon which maybe due to the lack of renal biopsy in most pateints with hyperbilirubinemia.Bile casts are analogous to ‘myeloma’ or myoglobin casts, as they have direct toxic effects on tubular epithelium with an obstructive capacity, which further predispose contrast related tubular injury in CI-AKI. Here, MB is linked to plasma cell myeloma.