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==Overview==
==Overview==
Renal cortical necrosis is a rare cause of acute [[renal failure]]. The condition is usually caused by significantly diminished renal arterial [[perfusion]] secondary to vascular spasm, microvascular injury, or [disseminated] intravascular coagulation and is the pathological progression of [[acute tubular necrosis]].  It is frequently associated with obstetric catastrophes such as [[abruptio placentae]] and [[septic shock]], and is three times more common in developing nations versus industrialized nations (2% versus 6% in causes of [[acute renal failure]]).
Renal cortical necrosis is a rare cause of acute [[renal failure]]. The condition is usually caused by significantly diminished renal arterial [[perfusion]] secondary to vascular spasm, microvascular injury, or [disseminated] intravascular coagulation and is the pathological progression of [[acute tubular necrosis]].  It is frequently associated with obstetric catastrophes such as [[abruptio placentae]] and [[septic shock]], and is three times more common in developing nations versus industrialized nations (2% versus 6% in causes of [[acute renal failure]]).


==Causes==
==Causes==
Line 15: Line 15:
**Prolonged intrauterine fetal death
**Prolonged intrauterine fetal death
**Severe [[eclampsia]]
**Severe [[eclampsia]]
* [[HIV]]<ref name="HIV">{{Cite pmid|22382240}}</ref>
* [[HIV]]<ref name="Singh-2012">{{Cite journal  | last1 = Singh | first1 = B. | last2 = Gupta | first2 = A. | last3 = Mahajan | first3 = S. | last4 = Gupta | first4 = R. | title = Acute cortical necrosis and collapsing glomerulopathy in an HIV-infected patient: a rare clinical scenario. | journal = Saudi J Kidney Dis Transpl | volume = 23 | issue = 2 | pages = 363-6 | month = Mar | year = 2012 | doi =  | PMID = 22382240 }}</ref>
* Snake bites<ref name="snakes">{{Cite pmid|22316624}}</ref>
* Snake bites<ref name="Kumar-2012">{{Cite journal  | last1 = Kumar | first1 = S. | last2 = Sharma | first2 = A. | last3 = Sodhi | first3 = KS. | last4 = Wanchu | first4 = A. | last5 = Khandelwal | first5 = N. | last6 = Singh | first6 = S. | title = Renal cortical necrosis, peripheral gangrene, perinephric and retroperitoneal haematoma in a patient with a viper bite. | journal = Trop Doct | volume = 42 | issue = 2 | pages = 116-7 | month = Apr | year = 2012 | doi = 10.1258/td.2011.110281 | PMID = 22316624 }}</ref>
* [[Binge drinking]]<ref> {{cite pmid|22215004}}</ref>
* [[Binge drinking]]<ref name="Jung-">{{Cite journal  | last1 = Jung | first1 = YS. | last2 = Shin | first2 = HS. | last3 = Rim | first3 = H. | last4 = Jang | first4 = K. | last5 = Park | first5 = MH. | last6 = Park | first6 = JS. | last7 = Lee | first7 = CH. | last8 = Kim | first8 = GH. | last9 = Kang | first9 = CM. | title = Bilateral renal cortical necrosis following binge drinking. | journal = Alcohol Alcohol | volume = 47 | issue = 2 | pages = 140-2 | month =  | year =  | doi = 10.1093/alcalc/agr154 | PMID = 22215004 }}</ref>
* [[Shock]]
* [[Shock]]
* [[Trauma]]
* [[Trauma]]
* [[Sickle cell disease]]<ref name="SCD and RCN"> {{cite pmid|22022093}}</ref>
* [[Sickle cell disease]]<ref name="Shiradhonkar-2011">{{Cite journal  | last1 = Shiradhonkar | first1 = S. | last2 = Jha | first2 = R. | last3 = Rao | first3 = BS. | last4 = Narayan | first4 = G. | last5 = Sinha | first5 = S. | last6 = Swarnalata | first6 = G. | title = Acute cortical necrosis following renal transplantation in a case of sickle cell trait. | journal = Indian J Nephrol | volume = 21 | issue = 4 | pages = 286-8 | month = Oct | year = 2011 | doi = 10.4103/0971-4065.78066 | PMID = 22022093 }}</ref>
* [[Systemic lupus erythematosus]] (SLE)<ref>{{Cite pmid|20169460}}</ref>
* [[Systemic lupus erythematosus]] (SLE)<ref name="Uppin-2010">{{Cite journal  | last1 = Uppin | first1 = MS. | last2 = Rajasekhar | first2 = L. | last3 = Swetha | first3 = H. | last4 = Srinivasan | first4 = VR. | last5 = Prayaga | first5 = AK. | title = Renal cortical necrosis at presentation in a patient with systemic lupus erythematosus: an autopsy case report. | journal = Clin Rheumatol | volume = 29 | issue = 7 | pages = 815-8 | month = Jul | year = 2010 | doi = 10.1007/s10067-010-1395-5 | PMID = 20169460 }}</ref>
*[[Sepsis]]<ref name="Sepsis and RCN"> {{cite pmid|22029648}}</ref>
*[[Sepsis]]<ref name="Huang-2011">{{Cite journal  | last1 = Huang | first1 = CC. | last2 = Huang | first2 = JK. | title = Sepsis-induced acute bilateral renal cortical necrosis. | journal = Nephrology (Carlton) | volume = 16 | issue = 8 | pages = 787 | month = Nov | year = 2011 | doi = 10.1111/j.1440-1797.2011.01478.x | PMID = 22029648 }}</ref>
* SLE-associated [[antiphospholipid syndrome]]<ref name="APLS and RCN"> {{cite pmid|21514023}}</ref>
* SLE-associated [[antiphospholipid syndrome]]<ref name="Kim-2011">{{Cite journal  | last1 = Kim | first1 = JO. | last2 = Kim | first2 = GH. | last3 = Kang | first3 = CM. | last4 = Park | first4 = JS. | title = Bilateral acute renal cortical necrosis in SLE-associated antiphospholipid syndrome. | journal = Am J Kidney Dis | volume = 57 | issue = 6 | pages = 945-7 | month = Jun | year = 2011 | doi = 10.1053/j.ajkd.2011.02.381 | PMID = 21514023 }}</ref>
* Vitamin deficiency<ref name="Vitamins and RCN"> {{cite pmid|20638557}}</ref>
* Vitamin deficiency<ref name="Novembrino-2010">{{Cite journal  | last1 = Novembrino | first1 = C. | last2 = De Giuseppe | first2 = R. | last3 = de Liso | first3 = F. | last4 = Bonara | first4 = P. | last5 = Bamonti | first5 = F. | title = Vitamin deficiency and renal cortical necrosis. | journal = Lancet | volume = 376 | issue = 9736 | pages = 160; author reply 161 | month = Jul | year = 2010 | doi = 10.1016/S0140-6736(10)61101-4 | PMID = 20638557 }}</ref>
* [[Pancreatitis]]<ref name="Pancreatits and RCN"> {{cite pmid|20436735}}</ref>
* [[Pancreatitis]]<ref name="Krishna-2009">{{Cite journal  | last1 = Krishna | first1 = GS. | last2 = Kishore | first2 = KC. | last3 = Sriram | first3 = NP. | last4 = Sainaresh | first4 = VV. | last5 = Lakshmi | first5 = AY. | last6 = Siva Kumar | first6 = V. | title = Bilateral renal cortical necrosis in acute pancreatitis. | journal = Indian J Nephrol | volume = 19 | issue = 3 | pages = 125 | month = Jul | year = 2009 | doi = 10.4103/0971-4065.57112 | PMID = 20436735 }}</ref>
* [[Malaria]]<ref>{{Cite pmid|18569922}}</ref>
* [[Malaria]]<ref name="Baliga-2008">{{Cite journal  | last1 = Baliga | first1 = KV. | last2 = Narula | first2 = AS. | last3 = Khanduja | first3 = R. | last4 = Manrai | first4 = M. | last5 = Sharma | first5 = P. | last6 = Mani | first6 = NS. | title = Acute cortical necrosis in Falciparum malaria: an unusual manifestation. | journal = Ren Fail | volume = 30 | issue = 4 | pages = 461-3 | month =  | year = 2008 | doi = 10.1080/08860220801964293 | PMID = 18569922 }}</ref>
* [[Meningococcemia]]<ref>{{Cite pmid|18516063}}</ref>
* [[Meningococcemia]]<ref name="Toh-2008">{{Cite journal  | last1 = Toh | first1 = HS. | last2 = Cheng | first2 = KC. | last3 = Kuar | first3 = WK. | last4 = Tan | first4 = CK. | title = The Case. Generalized petechiae and acute renal failure: bilateral renal cortical necrosis in meningococcemia. | journal = Kidney Int | volume = 73 | issue = 12 | pages = 1443-4 | month = Jun | year = 2008 | doi = 10.1038/ki.2008.143 | PMID = 18516063 }}</ref>
* Drug-induced toxicity (e.g. [[NSAIDs]], Contrast Media, [[Quinine]],<ref>{{Cite pmid|18343736}}</ref> or [[ATRA]]<ref>{{Cite pmid|18275266}}</ref>)
* Drug-induced toxicity (e.g. [[NSAIDs]], contrast Media, [[Quinine]], or [[ATRA]]<ref name="Leroy-2008">{{Cite journal  | last1 = Leroy | first1 = F. | last2 = Bridoux | first2 = F. | last3 = Abou-Ayache | first3 = R. | last4 = Belmouaz | first4 = S. | last5 = Desport | first5 = E. | last6 = Thierry | first6 = A. | last7 = Bauwens | first7 = M. | last8 = Touchard | first8 = G. | title = [Quinine-induced renal bilateral cortical necrosis]. | journal = Nephrol Ther | volume = 4 | issue = 3 | pages = 181-6 | month = Jun | year = 2008 | doi = 10.1016/j.nephro.2008.01.001 | PMID = 18343736 }}</ref><ref name="Sastre López-2007">{{Cite journal  | last1 = Sastre López | first1 = A. | last2 = Gago González | first2 = E. | last3 = Baños Gallardo | first3 = M. | last4 = Gómez-Huertas | first4 = E. | last5 = Ortega Suárez | first5 = F. | title = [All-trans retinoic acid syndrome [corrected] and renal cortical necrosis]. | journal = An Med Interna | volume = 24 | issue = 11 | pages = 551-3 | month = Nov | year = 2007 | doi =  | PMID = 18275266 }})</ref>


===Neonatal===
===Neonatal===
Line 38: Line 38:
*Placental [[hemorrhage]]
*Placental [[hemorrhage]]
*Severe [[hemolytic disease]]
*Severe [[hemolytic disease]]
*[[Sepsis]]<ref name="Sepsis and RCN"> {{cite pmid|22029648}}</ref>
*[[Sepsis]]<ref name="Huang-2011">{{Cite journal  | last1 = Huang | first1 = CC. | last2 = Huang | first2 = JK. | title = Sepsis-induced acute bilateral renal cortical necrosis. | journal = Nephrology (Carlton) | volume = 16 | issue = 8 | pages = 787 | month = Nov | year = 2011 | doi = 10.1111/j.1440-1797.2011.01478.x | PMID = 22029648 }}</ref>


==Pathophysiology==
==Pathophysiology==
The exact pathologic mechanism for RCN is unclear, however the onset of small vessel pathology is likely an important aspect in the etiology of this condition.  In general the renal medulla is under greater oxygen tension and more prone to ischemic injury, especially at the level of the proximal [[Collecting duct system|collecting tubule]], leading to its preferential damage in a sudden drop in perfusion.  Rapidly corrected acute renal ischemia leads to [[acute tubular necrosis]], from which complete recovery is possible, while more prolonged ischemia may lead to RCN.  Pathologically, the cortex of the kidney is grossly atrophied with relative preservation of the gross structure of the medulla.  The damage is usually bilateral owing to its underlying systemic causes, and is most frequently associated with pregnancy (>50% of cases).<ref name="Medscape"> {{Cite web |last1 =Deverajan  |first1 =Prasad |editor= Langman, Craig B |title = eMedicine: Renal Cortical Necrosis | url =http://emedicine.medscape.com/article/983599 | publisher = Medscape | date = May 26, 2011  | accessdate = 27 March 2012}} </ref> It accounts for 2% of all cases of acute renal failure in adults and more than 20% of cases of acute renal failure during late pregnancy.<ref>{{Cite pmid|20370445 }}</ref><ref>{{Cite pmid|7924011 }}</ref>
The exact pathologic mechanism for RCN is unclear, however the onset of small vessel pathology is likely an important aspect in the etiology of this condition.  In general the renal medulla is under greater oxygen tension and more prone to ischemic injury, especially at the level of the proximal [[Collecting duct system|collecting tubule]], leading to its preferential damage in a sudden drop in perfusion.  Rapidly corrected acute renal ischemia leads to [[acute tubular necrosis]], from which complete recovery is possible, while more prolonged ischemia may lead to RCN.  Pathologically, the cortex of the kidney is grossly atrophied with relative preservation of the gross structure of the medulla.  The damage is usually bilateral owing to its underlying systemic causes, and is most frequently associated with pregnancy (>50% of cases).  It accounts for 2% of all cases of acute renal failure in adults and more than 20% of cases of acute renal failure during late pregnancy.<ref name="Prakash-2010">{{Cite journal  | last1 = Prakash | first1 = J. | last2 = Niwas | first2 = SS. | last3 = Parekh | first3 = A. | last4 = Pandey | first4 = LK. | last5 = Sharatchandra | first5 = L. | last6 = Arora | first6 = P. | last7 = Mahapatra | first7 = AK. | title = Acute kidney injury in late pregnancy in developing countries. | journal = Ren Fail | volume = 32 | issue = 3 | pages = 309-13 | month = Jan | year = 2010 | doi = 10.3109/08860221003606265 | PMID = 20370445 }}</ref>
<ref name="Pertuiset-1994">{{Cite journal  | last1 = Pertuiset | first1 = N. | last2 = Grünfeld | first2 = JP. | title = Acute renal failure in pregnancy. | journal = Baillieres Clin Obstet Gynaecol | volume = 8 | issue = 2 | pages = 333-51 | month = Jun | year = 1994 | doi =  | PMID = 7924011 }}</ref>


==Diagnosis==
==Diagnosis==
While the only diagnostic "gold standard" mechanism of diagnosis en vivo is via renal biopsy, the clinical conditions and [[Coagulopathy|blood clotting disorder]] often associated with this disease may make it impractical in a clinical setting.  Alternatively, it is diagnosed clinically, or at autopsy, with some authors suggesting diagnosis by contrast enhanced [[Computerized Tomography|CT]].<ref name="Kim1996">{{Cite pmid|8846525}}</ref>
While the only diagnostic "gold standard" mechanism of diagnosis en vivo is via renal biopsy, the clinical conditions and [[Coagulopathy|blood clotting disorder]] often associated with this disease may make it impractical in a clinical setting.  Alternatively, it is diagnosed clinically, or at autopsy, with some authors suggesting diagnosis by contrast enhanced [[Computerized Tomography|CT]].<ref name="Kim-1996">{{Cite journal  | last1 = Kim | first1 = HJ. | last2 = Cho | first2 = OK. | title = CT scan as an important diagnostic tool in the initial phase of diffuse bilateral renal cortical necrosis. | journal = Clin Nephrol | volume = 45 | issue = 2 | pages = 125-30 | month = Feb | year = 1996 | doi =  | PMID = 8846525 }}</ref>
 


==Treatment==
==Treatment==
Line 50: Line 52:


==Prognosis ==
==Prognosis ==
Cortical necrosis is a severe and life threatening condition, with mortality rates over 50%.{{cn|date=March 2012}} Those mortality rates are even higher in neonates with the condition due to the overall difficult nature of neonatal care and an increased frequency of comorbid conditions.  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. Of those that survive the initial event, there are varying degrees of recovery possible, depending on the extent of the damage.
Cortical necrosis is a severe and life threatening condition, with mortality rates over 50%.  Those mortality rates are even higher in neonates with the condition due to the overall difficult nature of neonatal care and an increased frequency of comorbid conditions.  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. Of those that survive the initial event, there are varying degrees of recovery possible, depending on the extent of the damage.


== References ==
== References ==

Revision as of 00:57, 8 August 2013

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Vendhan Ramanujam M.B.B.S [2]

Synonyms and keywords: Acute cortical necrosis; acute renal failure with acute cortical necrosis; diffuse bilateral renal cortical necrosis; diffuse cortical necrosis

Overview

Renal cortical necrosis is a rare cause of acute renal failure. The condition is usually caused by significantly diminished renal arterial perfusion secondary to vascular spasm, microvascular injury, or [disseminated] intravascular coagulation and is the pathological progression of acute tubular necrosis. It is frequently associated with obstetric catastrophes such as abruptio placentae and septic shock, and is three times more common in developing nations versus industrialized nations (2% versus 6% in causes of acute renal failure).

Causes

In adults

Neonatal

Pathophysiology

The exact pathologic mechanism for RCN is unclear, however the onset of small vessel pathology is likely an important aspect in the etiology of this condition. In general the renal medulla is under greater oxygen tension and more prone to ischemic injury, especially at the level of the proximal collecting tubule, leading to its preferential damage in a sudden drop in perfusion. Rapidly corrected acute renal ischemia leads to acute tubular necrosis, from which complete recovery is possible, while more prolonged ischemia may lead to RCN. Pathologically, the cortex of the kidney is grossly atrophied with relative preservation of the gross structure of the medulla. The damage is usually bilateral owing to its underlying systemic causes, and is most frequently associated with pregnancy (>50% of cases). It accounts for 2% of all cases of acute renal failure in adults and more than 20% of cases of acute renal failure during late pregnancy.[14] [15]

Diagnosis

While the only diagnostic "gold standard" mechanism of diagnosis en vivo is via renal biopsy, the clinical conditions and blood clotting disorder often associated with this disease may make it impractical in a clinical setting. Alternatively, it is diagnosed clinically, or at autopsy, with some authors suggesting diagnosis by contrast enhanced CT.[16]


Treatment

Patients will require dialysis to compensate for the function of their kidneys.

Prognosis

Cortical necrosis is a severe and life threatening condition, with mortality rates over 50%. Those mortality rates are even higher in neonates with the condition due to the overall difficult nature of neonatal care and an increased frequency of comorbid conditions. 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. Of those that survive the initial event, there are varying degrees of recovery possible, depending on the extent of the damage.

References

  1. ↑ Singh, B.; Gupta, A.; Mahajan, S.; Gupta, R. (2012). "Acute cortical necrosis and collapsing glomerulopathy in an HIV-infected patient: a rare clinical scenario". Saudi J Kidney Dis Transpl. 23 (2): 363–6. PMID 22382240. Unknown parameter |month= ignored (help)
  2. ↑ Kumar, S.; Sharma, A.; Sodhi, KS.; Wanchu, A.; Khandelwal, N.; Singh, S. (2012). "Renal cortical necrosis, peripheral gangrene, perinephric and retroperitoneal haematoma in a patient with a viper bite". Trop Doct. 42 (2): 116–7. doi:10.1258/td.2011.110281. PMID 22316624. Unknown parameter |month= ignored (help)
  3. ↑ Jung, YS.; Shin, HS.; Rim, H.; Jang, K.; Park, MH.; Park, JS.; Lee, CH.; Kim, GH.; Kang, CM. "Bilateral renal cortical necrosis following binge drinking". Alcohol Alcohol. 47 (2): 140–2. doi:10.1093/alcalc/agr154. PMID 22215004.
  4. ↑ Shiradhonkar, S.; Jha, R.; Rao, BS.; Narayan, G.; Sinha, S.; Swarnalata, G. (2011). "Acute cortical necrosis following renal transplantation in a case of sickle cell trait". Indian J Nephrol. 21 (4): 286–8. doi:10.4103/0971-4065.78066. PMID 22022093. Unknown parameter |month= ignored (help)
  5. ↑ Uppin, MS.; Rajasekhar, L.; Swetha, H.; Srinivasan, VR.; Prayaga, AK. (2010). "Renal cortical necrosis at presentation in a patient with systemic lupus erythematosus: an autopsy case report". Clin Rheumatol. 29 (7): 815–8. doi:10.1007/s10067-010-1395-5. PMID 20169460. Unknown parameter |month= ignored (help)
  6. ↑ 6.0 6.1 Huang, CC.; Huang, JK. (2011). "Sepsis-induced acute bilateral renal cortical necrosis". Nephrology (Carlton). 16 (8): 787. doi:10.1111/j.1440-1797.2011.01478.x. PMID 22029648. Unknown parameter |month= ignored (help)
  7. ↑ Kim, JO.; Kim, GH.; Kang, CM.; Park, JS. (2011). "Bilateral acute renal cortical necrosis in SLE-associated antiphospholipid syndrome". Am J Kidney Dis. 57 (6): 945–7. doi:10.1053/j.ajkd.2011.02.381. PMID 21514023. Unknown parameter |month= ignored (help)
  8. ↑ Novembrino, C.; De Giuseppe, R.; de Liso, F.; Bonara, P.; Bamonti, F. (2010). "Vitamin deficiency and renal cortical necrosis". Lancet. 376 (9736): 160, author reply 161. doi:10.1016/S0140-6736(10)61101-4. PMID 20638557. Unknown parameter |month= ignored (help)
  9. ↑ Krishna, GS.; Kishore, KC.; Sriram, NP.; Sainaresh, VV.; Lakshmi, AY.; Siva Kumar, V. (2009). "Bilateral renal cortical necrosis in acute pancreatitis". Indian J Nephrol. 19 (3): 125. doi:10.4103/0971-4065.57112. PMID 20436735. Unknown parameter |month= ignored (help)
  10. ↑ Baliga, KV.; Narula, AS.; Khanduja, R.; Manrai, M.; Sharma, P.; Mani, NS. (2008). "Acute cortical necrosis in Falciparum malaria: an unusual manifestation". Ren Fail. 30 (4): 461–3. doi:10.1080/08860220801964293. PMID 18569922.
  11. ↑ Toh, HS.; Cheng, KC.; Kuar, WK.; Tan, CK. (2008). "The Case. Generalized petechiae and acute renal failure: bilateral renal cortical necrosis in meningococcemia". Kidney Int. 73 (12): 1443–4. doi:10.1038/ki.2008.143. PMID 18516063. Unknown parameter |month= ignored (help)
  12. ↑ Leroy, F.; Bridoux, F.; Abou-Ayache, R.; Belmouaz, S.; Desport, E.; Thierry, A.; Bauwens, M.; Touchard, G. (2008). "[Quinine-induced renal bilateral cortical necrosis]". Nephrol Ther. 4 (3): 181–6. doi:10.1016/j.nephro.2008.01.001. PMID 18343736. Unknown parameter |month= ignored (help)
  13. ↑ Sastre López, A.; Gago González, E.; Baños Gallardo, M.; Gómez-Huertas, E.; Ortega Suárez, F. (2007). "[All-trans retinoic acid syndrome [corrected] and renal cortical necrosis]". An Med Interna. 24 (11): 551–3. PMID 18275266. Unknown parameter |month= ignored (help))
  14. ↑ Prakash, J.; Niwas, SS.; Parekh, A.; Pandey, LK.; Sharatchandra, L.; Arora, P.; Mahapatra, AK. (2010). "Acute kidney injury in late pregnancy in developing countries". Ren Fail. 32 (3): 309–13. doi:10.3109/08860221003606265. PMID 20370445. Unknown parameter |month= ignored (help)
  15. ↑ Pertuiset, N.; Grünfeld, JP. (1994). "Acute renal failure in pregnancy". Baillieres Clin Obstet Gynaecol. 8 (2): 333–51. PMID 7924011. Unknown parameter |month= ignored (help)
  16. ↑ Kim, HJ.; Cho, OK. (1996). "CT scan as an important diagnostic tool in the initial phase of diffuse bilateral renal cortical necrosis". Clin Nephrol. 45 (2): 125–30. PMID 8846525. Unknown parameter |month= ignored (help)

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