Bilateral renal cortical necrosis

Abstract

Bilateral renal cortical necrosis is a pathological diagnosis of a clinical entity characterized by the abrupt onset of gross hematuria, oliguria and anuria, usually in individuals without known renal disease, and proceeding to a uremic syndrome with a predominantly fatal outcome. Pathologically, there is a patchy to diffuse bilateral ischemic coagulative cortical necrosis, with characteristic sparing of the renal medulla. Its greatest incidence is in pregnant women with accidental hemorrhage (abruptio placentae) in the last trimester. It may also occur in infants and children, usually as a result of diarrhea and dehydration, while in men it usually occurs as a result of infections or poisons. Its main clinical feature is the sudden onset of oliguria and anuria. The clinical diagnosis is difficult but is aided by percutaneous renal needle biopsy. Experimentally, it has been produced in animals principally by intravenous injection of bacterial toxins and vasoconstrictor substances. Although it is believed to result from spasm of renal interlobular arteries and afferent arterioles, its exact pathogenesis remains obscure. The treatment is similar to that employed in other causes of acute renal insufficiency. Proper management makes survival possible.