Acute Renal Cortical Necrosis

Abstract

Acute renal cortical necrosis is a rare cause of acute renal failure secondary to ischemic necrosis of the renal cortex. It accounts for only 2% of all causes of acute renal failure in developed countries (Grunfeld et al., 1981), but occurs more frequently in developing world (Chugh et al., 1976; Chugh et al., 1983; Hassan et al., 2009; Parkash et al., 1995). The obstetric complications are the commonest (50 – 70%) cause of renal cortical necrosis (Hassan et al., 2009), non-obstetric causes account for 20-30% of all cases of cortical necrosis and in these circumstances the incidence is higher in men than in women (Duff & More, 1941). Majority of the patients become dialysis dependent and occasional patients may recover partial kidney function and are dialysis-independent. Acute cortical necrosis is usually a bilateral condition, rarely being unilateral (Blau et al., 1971). The lesions are usually caused by significant prolonged diminished renal arterial perfusion secondary to vascular spasm, micro-vascular injury, or intravascular coagulation. Renal cortical necrosis is usually extensive although local or localized forms occur. Most of the patients present as acute renal failure and suspicion of the condition arises following prolonged oliguria and/or anuria. The kidney biopsy is the gold standard for the diagnosis.