Acute Bilateral Renal Cortical Necrosis Research Articles

Bilateral Renal Cortical Necrosis following Snake Envenomation: A Comprehensive Case Report and Analysis of the Underlying Pathophysiological Mechanisms and Treatment Approaches

Acute bilateral renal cortical necrosis (RCN) is a rare but potentially lethal form of renal injury that poses a diagnostic and therapeutic challenge for clinicians. The causes of renal cortical necrosis are multi-factorial. Renal cortical necrosis shows a higher incidence in men than women in non-obstetric cases, and its clinical presentation is heterogeneous, ranging from asymptomatic to severe renal failure. In this case report, we describe the clinical course of a patient who presented with acute renal failure following a venomous snake bite and was subsequently diagnosed with renal cortical necrosis. Despite aggressive management, the patient ultimately succumbed to death on the 24th day of admission. The present case highlights the importance of early diagnosis, prompt initiation of appropriate management, and effective prevention of complications in patients with renal cortical necrosis to improve patient outcomes and reduce morbidity and mortality. A timely and accurate diagnosis of renal cortical necrosis is critical for initiating appropriate interventions, and management should aim to address the underlying cause and prevent potential complications.

A rare entity of acute bilateral cortical renal necrosis following acute pancreatitis

Acute bilateral renal cortical necrosis following acute pancreatitis is extremely rare condition. Among all cases of acute renal failure, the incidence of renal cortical necrosis was 3.8% in one of the study in North India. Till date, only eight cases of bilateral cortical necrosis following acute pancreatitis were reported in the literature. We report a case of a 27-year-old male patient with abdominal pain, nausea and vomiting since 2 days duration and anuria since 24 h. Serum amylase and lipase were raised, and elevated serum creatinine was noted on admission. Contrast-enhanced computed tomography scan of the abdomen revealed changes of acute pancreatitis with hypoenhancement of renal cortex compared to medulla on both sides (reverse rim sign-stronger enhancement of the renal medulla compared to cortex), suggest an acute renal cortical necrosis.

Acute Bilateral Renal Cortical Necrosis in ELLP

Acute Bilateral Renal Cortical Necrosis in ELLP

Bilateral renal cortical necrosis with end-stage renal failure following envenoming by Proatheris superciliaris: A case report

Acute bilateral renal cortical necrosis (BRCN) has been reported following envenoming by exotic venomous snakes. Proatheris superciliaris is a rare viper with restricted distribution in east Africa. Very little information is available on envenoming by this species. We herein describe the case of a 60-year-old professional wildlife photographer who was bitten on his thumb while photographing an adult specimen of P. superciliaris that he held at home in France. On admission, physical examination revealed severe hypertension and bruising with edema at the bite site. Within the following 24 h, he developed vomiting, diarrhea, acute lumbar pain and anuria. Laboratory tests showed acute kidney injury (serum creatinine 4.6 mg/dL), with thrombocytopenia, anemia and severe coagulopathy. Contrast-enhanced computed tomography scan revealed hypodense areas in the cortex of both kidneys consistent with diffuse BRCN. As no appropriate antivenom existed, only symptomatic care was given to the patient. Coagulation tests returned to normal within 48 h. The patient was placed on chronic hemodialysis, until he underwent successful kidney transplantation 18 months later. In developed countries, severe complications provoked by snake bites tend to be more frequent with the number of trendy exotic pets. Acute kidney injury, including BRCN, is a classic complication of viper bites. The present case of end-stage renal failure related to diffuse BRCN illustrates the potentially devastating effects of envenoming by P. superciliaris. Clinicians in developed countries should be informed about renal disorders and other potentially fatal complications of venomous snake bites and seek urgent expert advice for optimizing clinical management. Education and coaching of envenomed patients and exotic snake owners is mandatory to prevent dramatic accidents.

Acute Bilateral Renal Cortical Necrosis Complicating Pyomyoma

Acute Bilateral Renal Cortical Necrosis Complicating Pyomyoma

Nécrose corticale rénale bilatérale induite par la quinine

Acute bilateral renal cortical necrosis is a rare cause of renal failure frequently induced by disseminated intravascular coagulation (Dic) following obstetrical complications, sepsis and drugs. We describe a case of Dic with bilateral cortical necrosis after ingestion of only one tablet of quinine. A 41-year-old woman was admitted for severe abdominal pain, melaena, fever and anuria two hours after quinine tablet intake for nocturnal leg cramps. Her medical history included angioneurotic edema caused by chloroquine for malaria prevention. Physical examination was normal. Laboratory data showed acute renal failure, hemolytic anemia without schistocytes and Dic. Platelet antibodies were negative. Ultrasonographic examination showed a complete defect of renal perfusion with permeable renal arteries. Results of abdominal CT scan and MAG3 scintigraphy led to the diagnosis of bilateral renal cortical necrosis. The patient underwent plasma exchanges with fresh frozen plasma which induced rapid resolution of Dic. She remained dependent on chronic hemodialysis. Quinine-induced microangiopathic hemolytic anemia and Dic is a rare described entity. These complications occur typically in quinine-sensitized subjects. The presence of acute renal failure is generally associated with poor prognosis in case of bilateral renal cortical necrosis. Caution is required for the prescription of quinine derivates, which should be avoided in patients experienced on adverse reaction to the drug.

Une cause exceptionnelle d'insuffisance rénale aiguë anurique : une nécrose corticale bilatérale aiguë paranéoplasique

Acute bilateral renal cortical necrosis is a very rare cause of acute renal failure which was mostly due to obstetrical causes in the 1970's. We report here for the first time a case of acute bilateral cortical necrosis associated with a paraneoplastic antiphospholipid syndrome.

Renal Cortical Necrosis Related to Paraneoplastic Antiphospholipid Syndrome

Acute bilateral renal cortical necrosis is a very rare cause of acute renal failure. We report here for the first time a case related to antiphospholipid syndrome, paraneoplastic of a lung neoplasia. A 46-year-old male smoker without medical history was admitted for acute dyspnea and anuria. Biological examination showed acute renal failure associated with hyperkalemia, high serum lactate dehydrogenase level, and prolonged activated thrombin time (ratio 1.29). Chest radiograph showed a right laterotracheal round lesion. A percutaneous left renal biopsy showed cortical necrosis, and renal arteriography confirmed bilateral cortical necrosis. Blood examination showed antiphospholipid antibodies type anticardiolipin. Chest computed tomographic scan confirmed the presence of a lung tumor. Two years after tumor surgery, the patient was still anuric and on long-term hemodialysis therapy, but antiphospholipid antibody results were negative. This case describes the first association of antiphospholipid syndrome to epidermoid lung cancer, shown by cortical bilateral necrosis. It also emphasizes the utility of renal biopsy in case of an unusual acute renal failure.

Acute bilateral renal cortical necrosis as a cause of postoperative renal failure

Acute renal failure after a major intra-abdominal operation is, unfortunately, not an infrequent occurrence. Acute tubular necrosis, the most common cause of postoperative renal failure, usually follows a predictable clinical course, with most patients recovering full renal function. We describe a patient who developed acute renal failure after orthotopic liver transplantation. Subsequent workup revealed the patient to have acute bilateral renal cortical necrosis. Bilateral renal cortical necrosis is an extremely rare cause of renal failure and an even rarer cause of postoperative renal failure. We discuss the diagnosis and management of this uncommon disorder and review the salient literature. Of the approximately 15 known reported cases involving native kidneys after a major nonobstetric abdominal operation in the world literature, we believe this is the first to be related to an orthotopic organ transplant.

MR imaging features of acute bilateral renal cortical necrosis

Bilateral renal cortical necrosis (BRCN) is an uncommon cause of acute renal failure. Kidney biopsy, arteriography, and contrast-enhanced computed tomography (CT) are usually used to diagnose BRCN. However, these methods can have potentially serious side effects. We report two cases in which magnetic resonance imaging (MRI) evidenced characteristic features of BRCN, which were confirmed by histological findings and arteriography and correlated with clinical evolution. In the first case report, the diagnosis of a massive and complete cortical necrosis variety was suggested on MRI that showed a thin rim of low signal intensity along border of kidneys. It was confirmed on kidney biopsy, and the renal function did not recover. The second case is an incomplete form with cortical patchy areas of low signal intensity. In these two patients, MRI helped to establish an early diagnosis of BRCN with characteristic representative findings, without the potential nephrotoxic effects of iodinated contrast that has to be used in CT and arteriography. Kidney biopsy, besides the risks of complications, provides only a parceled analysis of the renal tissue and therefore does not allow any conclusion as to the extension of cortical necrosis. MRI may be of great help for the diagnosis and follow-up of acute renal cortical necrosis.

A Case of Acute Renal Failure due to Acute Bilateral Renal Cortical Necrosis

A Case of Acute Renal Failure due to Acute Bilateral Renal Cortical Necrosis

The Diagnostic Value of Contrast-Enhanced CT in Acute Bilateral Renal Cortical Necrosis: A Case Report

The Diagnostic Value of Contrast-Enhanced CT in Acute Bilateral Renal Cortical Necrosis: A Case Report

Case report: The diagnostic value of contrast-enhanced computed tomography in acute bilateral renal cortical necrosis

Acute bilateral renal cortical necrosis is a relatively rare cause of acute renal failure accounting for only 2% of cases in the Western World. The pathophysiology of this condition is complex, but ultimately leads to the destruction of the renal cortex with sparing of the renal medulla. A definitive diagnosis is based on renal histology. In this report we describe a patient in whom this diagnosis was made using contrast-enhanced computed tomography as renal biopsy was contraindicated.