Renal cortical necrosis in tropics

Abstract

The aim of this study is to review cases of renal cortical necrosis (RCN) that were seen on renal biopsy at our center over a period of seven years. All renal biopsy records over seven years at the Osmania General Hospital were reviewed to identify patients with histologically proven RCN. The demographic, clinical, laboratory investigations and follow-up data were noted. There were a total of 105 patients with RCN. The mean age was 28.13 ± 12.40 years. Forty-one cases (39.04%) resulted from obstetric complications. The most common histology type of RCN was patchy cortical necrosis in 65 patients (62%). All patients required dialysis, and the mean duration of dialysis was 3 ± 1 weeks. Thirty-three (31.42%) patients progressed to end-stage kidney disease while three patients underwent renal transplantation. Ten (9.5%) patients succumbed to acute kidney injury. The remaining patients recovered sufficient renal function and were dialysis-independent till the last follow-up. RCN is an important cause of chronic kidney disease. Obstetric complications are the leading cause of RCN in our setting. An early renal biopsy, especially in cases of anuric renal failure, helps in establishing the diagnosis.

Renal cortical necrosis at autopsy: a 12 year experience at a tertiary care centre in Mumbai

“…Altered sensorium, unconsciousness and hepatic encephalopathy were seen in 5 cases (19.2%). The clinical presentation in most studies included renal failure, hematuria, flank pain and on examination shows costo-vertebral tenderness with palpable tender kidneys [8]. Laboratory investigations often reveal anemia, leukocytosis, thrombocytopenia, raised blood urea nitrogen, serum creatinine, lactate dehydrogenase and altered coagulation profile as was seen in our study [8,10,11].…”

“…We also found obstetric RCN to occur mainly in last trimester of pregnancy and in older multigravid women rather than primigravid women. The commonest non-obstetric cause in our study was septicemia followed by Hemolytic uremic syndrome and poisoning (1 [8,10].…”

“…Jai Prakash et al have reported diffuse cortical necrosis as 71.9% and patchy cortical necrosis as 28% on renal biopsies [1]. Sahay et al have reported diffuse cortical necrosis in 28.6% and patchy cortical necrosis as 71.4% on renal biopsies [8]. Chugh et all have reported DCN in 62.8% and patchy in 37.2% on renal biopsies [13].…”

“…Apart from it, other etiologies encountered were sepsis, abruptio placenta, spontaneous abortion and ruptured ectopic pregnancy. Obstetric catastrophies responsible for RCN in most reported series consists of abruptio placentae, septic abortion, eclamptic toxemia, PPH, IUFD, amniotic fluid embolism and puerperal sepsis [6,7,8,9]. In most literature series, abruptio placentae was the commonest etiology among obstetric causes of RCN.…”

Tranexamic Acid-Induced Acute Renal Cortical Necrosis in Post-Endoscopic Papillectomy Bleeding

“…Acute renal cortical necrosis (RCN) accounts for approximately 2% of all cases of acute renal failure. RCN has a poor prognosis and usually progresses to chronic renal failure [ 1 , 2 ]. RCN presumably occurs due to small renal blood vessel contraction, but this is unproven.…”