Renal cortical necrosis and papillary necrosis in an infant.

Abstract

Bilateral renal cortical necrosis (BRCN) and renal papillary necrosis have been reported in infancy as a complication of gastro-enteritis, perinatal asphyxia, utero-placental haemorrhage, septicaemia, exsanguination, kernicterus, eclampsia, renal vein thrombosis, fetomaternal transfusion and anoxic shock (Mauer and Nogrady, 1969; Leonidas, Berdon and Gribetz, 1971). We wish to report a case of combined BRCN and papillary necrosis, with some unusual radiological findings. A female infant aged three months presented with a fourday history of severe gastro-enteritis followed by convulsions. She was oliguric with metabolic acidosis. The urine contained protein and red cells. The blood urea was 184 and the serum creatinine 2·5 mg/100 ml. The patient had a spontaneous diuresis without requiring dialysis. In the diuretic phase fluid, electrolyte and acid-base balance was corrected with difficulty. Four weeks after the onset of the illness, an excretory urogram was performed. At the time of the examination the infant was well hydrated, polyuric, and 20 ml. of sodium iothalamate 54 per cent W/V (Conray 325) was injected intravenously. No calcification was present on the control film of the abdomen. Both kidneys were enlarged, measuring 7·5 cm in length. Prompt opacification of the calyces was seen, and all the calyces were noted to be dilated. The ureters were of normal calibre and there was no ureteric or bladder outlet obstruction. A striking feature was dense opacification of the renal cortex and the columns of Bertin, which occurred five minutes after injection of the contrast. The medullary zones were distinctly less opacified.