A Case of Renal Cortical Necrosis in a 15-year-old Boy with Acute Kidney Injury

Renal cortical necrosis (RCN) is patchy or diffuse ischemic destruction of the renal cortex caused by significantly reduced renal arterial perfusion. It is a rare cause of acute kidney injury (AKI) and is associated with high mortality. Here, we review the case of RCN in a 15-year-old boy who developed AKI. A 15-year-old boy was referred to our hospital from a local hospital due to a sharp decrease in his renal function. He presented with acute flank pain, nausea with vomiting, and oliguria for the past two days. He had taken a single dose of antihistamine for nasal congestion. At our hospital, his peak blood pressure was 148/83 mmHg and he had a high body mass index of 32.9 kg/m². The laboratory data showed a blood urea nitrogen (BUN) of 28.4 mg/dL, a creatinine of 4.26 mg/dL, and a glomerular filtration rate estimated from the serum cystatin C of 20.2 mL/min/1.73m². Proteinuria (spot urine protein to creatinine ratio 1.66) with pyuria was observed. Kidney sonography showed parenchymal swelling and increased renal echogenicity. Due to rapidly progressing nephritis, steroid pulse therapy (750 mg/IV) was done on the second day of his admission and the patient showed complete recovery with normal renal function. However, the kidney biopsy findings revealed renal cortical hemorrhagic necrosis. Multifocal, relatively well-circumscribed, hemorrhagic necrotic areas (about 25%) were detected in the tubulointerstitium. Although RCN is an unusual cause of AKI, especially in children, pediatricians should consider the possibility of RCN when evaluating patients with rapidly decreasing renal function.

Complete Recovery of Renal Function in Bilateral Renal Cortical Necrosis: A Case Report / 대한신장학회지

Acute bilateral renal cortical necrosis (BRCN) is a rare cause of renal failure. It has been reported that contrast-enhanced computed tomography provides characteristic findings of BRCN which correlates well with the histopathology making it an important non-invasive diagnostic modality during early phase of BRCN, improving survival rate and prognosis with early diagnosis and treatment. This report presents a case of 73-year old woman with BRCN due to hemolytic uremic syndrome. The patient recovered from anuria and showed complete recovery to normal renal function of her age and serum creatinine level after early initiation of hemodialysis. Furthermore, a normal radiologic finding of kidney was obtained after 52 days from onset of the disease by contrast-enhanced computed tomography. At present, she is preserved within the normal range renal function without renal replacement therapy.

A Case of Acute Bilateral Renal Cortical Necrosis Associated with Peritonitis and Intra-abdominal Operation / 대한신장학회지

Renal cortical necrosis (RCN) is a rare cause of acute renal failure in which there is a complete or partial destruction of the renal cortex with sparing of the medulla. We report here a case of acute bilateral RCN associated with intra-abdominal operation. A 70-year-old female patient was admitted to our hospital because of abdominal pain secondary to perforated diverticulits in sigmoid colon. A segmental resection of the sigmoid colon and end-to-end anastomosis was performed on the third hospital day. Two days later, she suddenly developed oligo-anuria and she was treated with hemodialysis. A contrast-enhanced abdominal computed tomography scan showed lack of enhancement of the renal cortex with enhancement of the renal medulla. On the 21th hospital day, renal biopsy was done and microscopic examination of the specimen revealed RCN. Since then, she has been on regular hemodialysis for over six months with no signs of renal recovery. Occult sepsis associated with peritonitis and intra-abdominal operation seems to be the most possible etiologic factor of RCN in our patient.

Two Cases of Acute Renal Cortical Necrosis Diagnosed by Contrast-Enhanced Computerized Tomography / 대한신장학회지

Renal cortical necrosis (RCN) is a relatively rare cause of acute renal failure. In the past, the incidence of RCN was more higher in obstetrical patients than in non-obstetric patients. But during the last 15 years, the prevalence of RCN in non-obstetric patients have overwhelmed the obstetrical patients. Renal biopsy was an only gold standard diagnostic method for RCN in the past even though it was not performed frequently because of the serious clinical circumstances and coagulopathy generally accompanied by RCN, especially during the early period. Recently, contrast-enhanced computerized tomography was found to provide very characteristic representative findings. Therefore, the importance of contrast-enhanced computerized tomography as non-invasive diagnostic procedure during the initial phase of RCN is stressed. We report two cases of RCN which we have diagnosed early by using contrast-enhanced computerized tomography and treated by hemodialysis.

Acute Bilateral Renal Cortical Necrosis Associated with Diclofenac Sodium / 대한신장학회잡지

Acute bilateral renal cortical necrosis is relatively unusual cause of acute renal failure (ARF). We report a rare case of acute bilateral renal cortical necrosis associated with diclofenac sodium. A 57-year-old man visited to our hospital with progressive oligoanuria for three days. Four days earlier, after diclofenac sodium 150 mg was injected intramuscularly at local hospital, he experienced anaphylactic shock. Our laboratory findings revealed the existence of fibrin split, thrombocytopenia, coagulopathy, and microangiopathic hemolytic anemia (MAHA). These findings were compatible with disseminated intravascular coagulation (DIC). The radiocontrast enhancement CT scan showed a bilateral lack of enhancement of the renal cortex after contrast infusion, enhancement of renal medulla, and the absence of renal excretion of the contrast dye. Renal biopsy showed a cortical necrosis with congested acellular glomuruli and necrotic tubules. Empiric treatment including hemodialysis was commenced. Although his renal function was not completely recovered, he is now being followed up at this hospital without dialysis.

A Case of Bilateral Renal Cortical Necrosis Associated with Acute Pancreatitis / 대한신장학회잡지

Bilateral cortical necrosis accounts for up to 2% of cases of acute renal failure. More than half of cases of bilateral renal cortical necrosis occure in association with pregnancy complicated by antipartum or postpartum hemorrhage. Other causes including severe bacterial infections, hemolytic uremic syndrome, trauma, postoperative shock, burns, Acute pancreatitis, diabetic ketoacidosis, snake venoms, and phosphorus poisoning. A 53-year-old woman presented with acute pancreatitis and acute renal failure. Diffuse bilateral renal cortical necrosis was diagnosed by renal biopsy and computed tomography. The patient recovered from the attack of pancreatitis but remained anuric. Then, we report this case of acute renal cortical necrosis associated with acute pancreatitis.

A Case of Bilateral Renal Cortical Necrosis Associated with Acute Pancreatitis / 대한신장학회잡지

Bilateral cortical necrosis accounts for up to 2% of cases of acute renal failure. More than half of cases of bilateral renal cortical necrosis occure in association with pregnancy complicated by antipartum or postpartum hemorrhage. Other causes including severe bacterial infections, hemolytic uremic syndrome, trauma, postoperative shock, burns, Acute pancreatitis, diabetic ketoacidosis, snake venoms, and phosphorus poisoning. A 53-year-old woman presented with acute pancreatitis and acute renal failure. Diffuse bilateral renal cortical necrosis was diagnosed by renal biopsy and computed tomography. The patient recovered from the attack of pancreatitis but remained anuric. Then, we report this case of acute renal cortical necrosis associated with acute pancreatitis.

A Case of Diffuse Cortical Necrosis after Glue Sniffing / 대한신장학회잡지

The renal cortical necrosis occurs in approximately 2% of adult patients with acute renal failure. The causes of renal cortical necrosis were usually associated with obstetrical problems. However, the distinctive changes occurred over the past 15 years in the etiology with a high incidence of non-obstetric causes than obstetric ones. We experienced a rare case of diffuse bilateral renal cortical necrosis in 16-year-old man who had a history of glue sniffing. To our knowledge, this is the first report in our country. A 16-year-old man was admitted with vague flank pain and oliguria. There was history of frequent adhesive glue sniffing. Laboratory data were as follows : BUN 77mg/dL, creatinine, 9.3mg/dL, protein 3+, RBC many/HPF, WBC 1-4/HPF in urinalysis, HBsAg(-), Anti-HBs(+), C(3)10.5mg/dL, C(4)7.4mg/dL), IgG 1,865mg/mL, IgA 512mg/mL. The kindey size was normal in ultrasonography. Renal cortex was diffusely not enhanced in MIJ Tl weighted image. Diffuse bilateral renal cortical necrosis was diagnosed by renal biopsy. In this case, adhesive glue sniffing may be a cause of acute cortieal necrosis.