Renal opacification during intravenous urography in acute cortical necrosis (the nephrogram in cortical necrosis).

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Acute renal cortical necrosis is a rare cause of acute renal failure. It can occur following a variety of insults but has been most commonly reported following obstetric complications (Kleinknecht et al., 1973). The diagnosis is suspected when there is oliguria or anuria with little or no recovery within six weeks of onset in an appropriate clinical context. Confirmation of the diagnosis is usually made by renal biopsy but this may be unreliable if the necrosis is patchy (Wells et al., 1960; Kleinknecht et al., 1973). The radiographic demonstration of cortical “tramline” calcification has also been used to confirm a provisional diagnosis but only a minority of patients with cortical necrosis will develop this feature (Deutsch et al., 1971; Kleinknecht et al., 1973) and it is unusual to see such calcification until at least four weeks after the onset of necrosis. It has been shown that distinctive appearances may be seen during renal arteriography and that these appearances may be used to confirm a diagnosis of acute cortical necrosis at an early stage (Deutsch et al., 1971; Kleinknecht et al., 1973). It is usually thought that opacification of the renal substance during intravenous urography does not occur in patients with acute cortical necrosis. However, three cases showing such opacification have been reported in the French literature (Joffre et al., 1976) and the following case report is a further example. In all four cases the pattern of opacification was characteristic.