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 [1]. 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 [1] [2]. 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 [1] [2]. 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 [3]. 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 [1]. 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 [1] [2]. This condition usually results in acute kidney failure.

• Sepsis

  Blood cultures later confirmed Neisseria meningitidis sepsis, and a biopsy confirmed renal cortical infarction. [ncbi.nlm.nih.gov]

  Abdominal pain and fever, which may be severe in sepsis, can also appear. [symptoma.com]

  CBC often detects leukocytosis (even when sepsis is not the cause) and may detect anemia and thrombocytopenia if hemolysis, disseminated intravascular coagulation (DIC), or sepsis is the cause. [msdmanuals.com]

• Abdominal Pain

  The patient presented with worsening symptoms consisting of arthralgias, pruritus, and abdominal pain. Laboratory data obtained was indicative of worsening renal failure and thrombocytopenia. The patient required hemodialysis by the third day. [ncbi.nlm.nih.gov]

  2009/19/3/125/57112 A 22-year-old male with no premorbid illness presented to emergency with vomiting, peri umbilical abdominal pain with pain radiating to the back following an alcoholc binge. He developed oliguria followed by anuria over two days. [doi.org]

  Abdominal pain and fever, which may be severe in sepsis, can also appear. [symptoma.com]

• Oliguria

  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]

  […] correspondence to Affiliations Department of Pathology, Microbiology and Immunology, Vanderbilt University, Nashville, TN Clinical and Pathologic Features Cortical necrosis commonly manifests clinically as a rapid loss of glomerular filtration rate, often with oliguria [ajkd.org]

• Kidney Failure

  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]

  failure N17.0 Acute kidney failure with tubular necrosis N17.1 Acute kidney failure with acute cortical necrosis N17.2 Acute kidney failure with medullary necrosis N17.8 Other acute kidney failure N17.9 Acute kidney failure, unspecified N18 Chronic kidney [icd10data.com]

  kidney failure with medullary necrosis N178Other acute kidney failure N179Acute kidney failure, unspecified N181Chronic kidney disease, stage 1 N182Chronic kidney disease, stage 2 (mild) N183Chronic kidney disease, stage 3 (moderate) N184Chronic kidney [cms.gov]

  2012 ICD-9-CM Diagnosis Code 584.6 Acute kidney failure with lesion of renal cortical necrosis Short description: Ac kidny fail, cort necr. [icd9data.com]

  This condition usually results in acute kidney failure. [symptoma.com]

• Cesarean Section

  section Normal Cesarean section Normal Normal Blood pressure (mmHg) 180/100 150/80 160/90 170/80 160/110 Urine output (mL/24h) 700 400 Biological findings -Serum creatinin: 6.35 mg/dL -Hemoglobin level: 2.9 g/dL -Platelets: 180,000/mm 3 -Proteinuria: [omicsonline.org]

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 [4], while magnetic resonance imaging (MRI) and contrast-enhanced ultrasonography may be used as well [1] [2] [4]. Although recommended in only a subset of patients due to its potential risks, renal biopsy is the gold standard for the diagnosis of RCN [5], 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 [1] [3].

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/Pathogenesis Thrombosis of interlobular or larger arteries causes cortical infarcts. Obstetric complications, particularly placental abruption and eclampsia, are common causes. [ajkd.org]

Hann L, Pfister RC: Renal subcapsular rim sign: New etiologies and pathogenesis. AJR 138 :51–54, 1982 PubMed Google Scholar Copyright information Authors and Affiliations Carlos M. Badiola-Varela 1 1. [link.springer.com]

[…] following: Sepsis [5] Shock Trauma Snakebite [6] [7] Hyperacute kidney transplant rejection Poisons Drugs (eg, nonsteroidal anti-inflammatory drugs [NSAIDs]) Contrast media Malaria [8] Antiphospholipid syndrome [9] [10] Smoking synthetic cannabinoids [11] Epidemiology [emedicine.medscape.com]

Epidemiology Microscopic nephrocalcinosis is a common incidental finding at post-mortem but macroscopic nephrocalcinosis is uncommon. [patient.info]

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]

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]

NSAIDs, Contrast Media, Quinine,[13] or ATRA[14]) Babies[edit] Congenital heart disease Fetal-maternal transfusion Dehydration Perinatal asphyxia Anemia Placental hemorrhage Severe hemolytic disease Sepsis[7] Pathophysiology[edit] The exact pathologic [en.wikipedia.org]

The exact pathophysiology is uncertain. [mjdrdypu.org]

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]

Treat your inpatient and ambulatory patients more effectively with the absolute latest on new topics such as quality improvement and patient care safety *school violence and bullying * preventive measures * vitamin deficiencies * adolescent rape * effect [books.google.com]

1. 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.
2. Prakash J, Srivastava A, Singh S, Ghosh B. Renal cortical necrosis in a live kidney donor. Indian J Nephrol. 2012;22(1):48-51.
3. 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.
4. 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.
5. 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.