Renal cortical necrosis, defined as the ischemia of the renal cortex with sparing of the medulla, is a rare, but very dangerous and life-threatening complication of the acute renal injury. Anuria, hematuria and a profoundly poor overall general condition are important clinical features. The diagnosis, made through laboratory and imaging studies, must be made early on, in order to increase the chances of survival.
Renal cortical necrosis (RCN), responsible for approximately 2-7% of all acute kidney injuries (AKIs), can have a rapidly progressing clinical course that may result in death without early recognition . Diminished perfusion of the renal cortex in both kidneys (as the underlying diseases are primarily of systemic etiology), occurs as a result of vascular spasm, coagulation, or microvascular injury, which may be seen in a myriad of disorders: hemolytic-uremic syndrome (HUS), placental abruption, sepsis, hemorrhagic shock (during pregnancy as well), eclampsia, extensive burn injury or severe dehydration resulting in hypovolemia, pancreatitis, snake bites and malaria  . RCN may also be induced by several drugs, such as aminoglycosides, beta-lactam antibiotics, and non-steroidal anti-inflammatory drugs (NSAIDs), whereas post-nephrectomy of kidney donors may also result in RCN  . Because of the nature of the condition, RCN is predominantly encountered in early infancy (HUS, sepsis, dehydration) and in women of childbearing age, when puerperal sepsis and placental abruption are responsible for the majority of cases . Regardless of the underlying cause, an acute onset of absolute or relative anuria (defined as excretion of 0 or < 100 mL of urine per 24h, respectively) lasting for several days or even weeks is the typical clinical presentation . Abdominal pain and fever, which may be severe in sepsis, can also appear. In addition, hematuria, both gross and/or microscopic, gastrointestinal hemorrhage, pulmonary edema and profound uremia lead to shock and multiorgan failure in many patients, and a fatal outcome is often seen without immediate initiation of dialysis  . This condition usually results in acute kidney failure.
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Cotton Wool Spots
The patient's retinopathy included bilateral hemorrhages and cotton wool spots; visual fields and acuity remained normal. Funduscopic lesions disappeared by three months after the acute event. [ncbi.nlm.nih.gov]
Fig. 2 Fundus photographs of both eyes show cotton wool spots at the posterior pole and peripapillary areas. [jmedicalcasereports.biomedcentral.com]
One patient spontaneously recovered renal function after prolonged oliguria. This case should be added to the small number of similar case reports in the literature. [ncbi.nlm.nih.gov]
He developed oliguria followed by anuria over two days. On examination, he was hemodynamically stable (BP - 120/80 mm of Hg) and had tenderness in the epigastrium and right hypochondriac areas. [doi.org]
The extent of the necrosis is a major determinant of the prognosis, which in turn is dependent on the duration of ischemia, duration of oliguria, and the severity of the precipitating conditions. [en.wikipedia.org]
It accounts for 2% of all cases of acute kidney failure in adults and more than 20% of cases of acute kidney failure during late pregnancy. [en.wikipedia.org]
From Wikidata Jump to navigation Jump to search rare cause of acute kidney failure renal cortical necrosis renal cortical necrosis NOS Renal cortical necrosis、RCN acute renal failure with lesion of renal cortical necrosis edit English kidney cortex necrosis [wikidata.org]
Convert to ICD-10-CM : 583.6 converts approximately to: 2015/16 ICD-10-CM N17.1 Acute kidney failure with acute cortical necrosis Applies To Nephritis NOS with (renal) cortical necrosis Nephropathy NOS with (renal) cortical necrosis Renal cortical necrosis [icd9data.com]
Ten days after the vesicle eruption appearance, he presented with ecchymosed heels, oligoanuric kidney failure, anemia [hemoglobin (Hb) 78 g/L], schizocytosis (2.5%), but normal platelet count. [ncbi.nlm.nih.gov]
Rapid detection of kidney failure is detrimental in order to save the life of the patient, which is why a detailed patient history and a thorough physical examination that will assess vital signs, history of urinary output, and note accompanying symptoms, are essential steps. A detailed laboratory workup comprising serum electrolyte levels (sodium, potassium, chloride, calcium, bicarbonate), arterial blood gas analyses (ABGs), kidney function tests (blood urea nitrogen and creatinine), a complete blood count (CBC) and urinalysis must be performed immediately, whereas imaging studies of the kidneys, either through ultrasonography or computed tomography (CT) should be subsequently employed. In fact, contrast-enhanced CT is considered as a very effective non-invasive method for early detection of RCN because it may identify a hypoattenuated subcapsular rim of the renal cortex , while magnetic resonance imaging (MRI) and contrast-enhanced ultrasonography may be used as well   . Although recommended in only a subset of patients due to its potential risks, renal biopsy is the gold standard for the diagnosis of RCN , which is classified into two types based on histopathological findings: diffuse, characterized by widespread cortical destruction; and patchy, where 30-50% of the cortical tissue is affected by ischemic necrosis  .
Renal function improved partially after treatment with plasma exchange, steroids, and cyclophosphamide. [ncbi.nlm.nih.gov]
The renal prognosis improved as a result of the decreased mortality of patients. [ncbi.nlm.nih.gov]
RESULTS: The incidence of RCN was 3.12% of all cases of ARF of diverse etiology. RCN was observed in 57 patients; obstetric 32 (56.2%); non-obstetric 25 (43.8%). [ncbi.nlm.nih.gov]
Etiology severe hemodynamic shock traumatic blood loss postpartum hemorrhage septic shock venom toxin transfusion reaction severe dehydration microangiopathic hemolysis hemolytic uremic syndrome (HUS) renal transplantation CT Contrast-enhanced CT demonstrates [radiopaedia.org]
[…] following: Sepsis  Shock Trauma Snakebite   Hyperacute kidney transplant rejection Poisons Drugs (eg, nonsteroidal anti-inflammatory drugs [NSAIDs]) Contrast media Malaria  Antiphospholipid syndrome   Smoking synthetic cannabinoids  Epidemiology [emedicine.medscape.com]
Epidemiologic studies, clinical description, and comparison of P. vivax with P. falciparum are needed to understand the dynamics and its interaction with the immune system. [indianjnephrol.org]
Synthetic cannabinoids: epidemiology, pharmacodynamics, and clinical implications. Drug Alcohol Depend. 2014; 144 :12-41. [ PubMed ] [ DOI ] 5. Kunos G, Járai Z, Bátkai S, Goparaju SK, Ishac EJ, Liu J, Wang L, Wagner JA. [wjgnet.com]
The pathophysiology of this condition is complex, but ultimately leads to the destruction of the renal cortex with sparing of the renal medulla. A definitive diagnosis is based on renal histology. [ncbi.nlm.nih.gov]
Brenner/Rector remains the go-to resource for practicing and training nephrologists and internists who wish to master basic science, pathophysiology, and clinical best practices. [books.google.com]
Endothelial injury, caused by the potent vasoconstrictor endothelin-1, has been implicated in the pathophysiology of RCN. [e-ce.org]
The exact pathophysiology is uncertain. [mjdrdypu.org]
Furthermore, the protective effect of various pharmacologic agents against 2 and 3 h of normothermic ischemia is investigated and the pathophysiology of renal ischemic damage is pointed out. 1976 S. [karger.com]
Local infusion of anticoagulants or thrombolytic drugs into one renal artery offers the possibility of a controlled examination of the efficacy of this treatment in preventing cortical necrosis. [ncbi.nlm.nih.gov]
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- Prakash J, Singh VP. Changing picture of renal cortical necrosis in acute kidney injury in developing country. World Journal of Nephrology. 2015;4(5):480-486.
- Prakash J, Srivastava A, Singh S, Ghosh B. Renal cortical necrosis in a live kidney donor. Indian J Nephrol. 2012;22(1):48-51.
- Prakash J, Vohra R, Wani IA, Murthy AS, Srivastva PK, Tripathi K, et al. Decreasing incidence of renal cortical necrosis in patients with acute renal failure in developing countries: a single-centre experience of 22 years from Eastern India. Nephrol Dial Transplant. 2007;22(4):1213-1217.
- François M, Tostivint I, Mercadal L, Bellin MF, Izzedine H, Deray G. MR imaging features of acute bilateral renal cortical necrosis. Am J Kidney Dis. 2000;35(4):745-748.
- Aksoy S, Hocaoglu E, Karahasanoglu A, Igus B, Acay MB, Inci E. Bisphosphonate-induced bilateral acute renal cortical necrosis. Radiology Case Rep. 2015;10(2):992.