Renal Cortical Necrosis Research Articles

Renal Cortical Necrosis in Pregnancy: A Rare Yet Critical Condition with Varied Pathogenic Mechanisms

Renal Cortical Necrosis in Pregnancy: A Rare Yet Critical Condition with Varied Pathogenic Mechanisms

Etiological spectrum of acute kidney injury and adverse outcome: A single-center observation

ABSTRACT Background: The present study aims to evaluate the etiological spectrum with clinicopathological parameters and adverse outcomes of acute kidney injury (AKI). Methods: A hospital-based prospective observational study was conducted for a spectrum of AKI in 103 AKI patients and their AKI-associated adverse outcomes. The AKI patients were included as per the KDIGO definition. The patients with a known chronic kidney disease (CKD) were excluded from the study population. A clinicopathological association with AKI was observed. Adverse outcomes and the need for renal biopsy were recorded in 3 weeks followed up to 6 months. Results: A single-center study recorded that the incidence of AKI was 8.6% with a mean age of 34 ± 16 years. The cause of AKI due to medical reasons was maximum (70.8%), followed by obstetric (21.3%) and surgery (7.7%). The AKI mortality rate was 16% (P < 0.05). Renal biopsy in 34 cases showed that acute tubular necrosis was higher (38%), followed by acute cortical necrosis (23%). The spectrum of AKI was very diverse. In the 6-month follow-up, the adverse outcome was observed in 27.2% of patients, where the mortality rate was 16.5% and 10.7% of patients progressed to CKD. Conclusion: The spectrum of AKI was diverse among the population, and most of the etiologies are preventable. This alarms the need for better preventive strategies with a better referral system. The obstetric population with AKI, which majorly leads to either mortality or progression to CKD, is the section that seeks more attention.

Acute Kidney Cortical Necrosis following Cardiac Catheterization: A Diagnostic Challenge

Acute Kidney Cortical Necrosis following Cardiac Catheterization: A Diagnostic Challenge

Pregnancy-Related Complications and Snake Bites Are Leading Causes of Renal Cortical Necrosis in India

Pregnancy-Related Complications and Snake Bites Are Leading Causes of Renal Cortical Necrosis in India

Postpartum Renal Cortical Necrosis: A Case Series

Rationale & ObjectivePostpartum renal cortical necrosis (postpartum RCN) is a severe form of obstetric acute kidney injury. This study aimed to identify clinicopathological features in Chinese postpartum RCN cases to determine how pathologic findings may contribute to the treatment and prognosis. Study DesignSingle-center, case series Setting & ParticipantsTwelve patients with postpartum RCN had kidney biopsies at Peking University First Hospital between 2014 and 2021. The diagnosis of postpartum RCN was made according to typical MRI or pathological features. Clinical, laboratory and pathological data were compared between patients with eGFR <30 (poor outcome) and ≥30 ml/min/1.73 m2 after six months. ObservationsAll postpartum RCN patients presented with stage 3 AKI attributed to a probable atypical hemolytic uremic syndrome. Pregnancy terminations occurred at a median gestational age of 35.5 weeks. Kidney biopsy was performed ranging 18 days to 4 months from delivery. Upon biopsy, hemoglobin, platelet count and LDH levels had been restored to 137 g/L, 214 ×109/L and 231.50±65.01 U/L, respectively. Four patients exhibited poor outcome, demonstrating higher schistocyte count, serum creatinine and mean arterial pressure at onset. Pathologically, glomerular segmental sclerosis was prevalent. The NOS variant was the most common type, followed by collapsing variant, cellular variant, and tip variant. Patients with poor kidney outcome had more glomerular coagulative necrosis, capillary thrombosis, extensive cortical coagulative necrosis, and pronounced arteriole/artery lesions including increased interlobular arteriole intimal edema and fibrin thrombosis, but a lower occurrence of segmental sclerosis. LimitationsLimited sample size and retrospective design. ConclusionsOur research has identified key pathological features in postpartum RCN patients with aHUS, highlighting the necessity for more effective therapeutic options. There is a clear demand for non-invasive biomarkers that can accurately track disease progression and inform treatment duration for long-term outcomes improvement.

Safety assessment of tranexamic acid: real-world adverse event analysis from the FAERS database.

In recent years, with the continuous expansion of the application scope of Tranexamic acid (TXA), its usage has surged. Despite numerous studies demonstrating its powerful efficacy, concerns regarding its adverse reactions persist, necessitating comprehensive safety assessment. This study analyzed real-world data from the U.S. Food and Drug Administration to investigate TXA-related adverse events, aiming to elucidate its safety and optimize patient treatment. The adverse drug event data concerning TXA from 2004 Q1 to 2023 Q3 were collected. Following data standardization, a variety of signal quantification techniques, including the reporting odds ratios, proportional reporting ratios, Bayesian confidence propagation neural network, and empirical Bayes geometric mean were used for analysis. After analyzing 16,692,026 adverse event reports, a total of 1,574 cases of adverse events related to TXA were identified, spanning 23 system organ classes and 307 preferred terms. In addition to the common thrombosis-related Vascular disorders (n = 386) and Cardiac disorders (n = 377), adverse reactions in the Nervous system disorders category were also observed (n = 785), including Myoclonus (n = 70), Status epilepticus (n = 43), and Myoclonic epilepsy (n = 17). Furthermore, this study uncovered adverse effects such as Renal cortical necrosis, Hepatic cyst rupture, and Vascular stent stenosis, which were not previously mentioned in the instructions. Although these occurred infrequently, they exhibited high signal strength. Both Retinal artery occlusion and Vascular stent thrombosis disorder were frequent and exhibited high signal strength as well. It is worth noting that 78 cases of adverse reactions were caused by confusion between incorrect product administration. Our research suggests that TXA has some adverse reactions that are being overlooked. As a cornerstone medication in hemorrhage treatment, it's crucial to monitor, identify, and address these adverse reactions effectively.

#2781 Renal cortical necrosis—a rare cause of acute kidney injury

Abstract Background and Aims Renal cortical necrosis (RCN) is a rare and catastrophic cause of acute kidney injury (AKI). It is characterized by ischemic destruction of all the elements of renal cortex due to marked reduction in renal arterial perfusion of renal cortex due to vascular spasm and microvascular injury. It can be patchy or diffuse depending upon the cause and extent of hypoperfusion. Snake bite is rare cause of RCN. Incidence of RCN following snake bite has been reported to be as high as in 25% of the bitten patients to &amp;lt;1%. Lack or delay in receiving anti snake venom (ASV) has been observed to be a contributing factor in development of RCN following snake bite. Method A 45-year-old female had an unknown bite on foot while returning to home at twilight. She had intense pain at site of bite with slight ooze of blood. Overnight she had vomiting and pain abdomen. Subsequently she developed progressive fall in urine output and dyspnoea. After about 36 hours of bite at the time of admission in hospital she had anuria, prolonged whole blood clotting time, tachypnoea, hypoxemia and required oxygen (O2) to maintain normal O2 saturation. She was given two doses of polyvalent ASV 6 hours apart which corrected her coagulation defect. Investigations showed: haemoglobin—9 gm/dl, total leucocyte count—18700/mcl, platelet—1.15 lakh/mcl, blood urea—88 mg/dl and serum creatinine—10.5 mg/dl. She was managed with haemodialysis and supportive care. Even after 3 weeks of onset of AKI, she had anuria so a kidney biopsy was done. Results kidney biopsy on light microscopy examination showed 9 glomeruli; 8 revealing global tuft necrosis along with necrosis of adjacent tubules and vasculature and necrotic process affected around 60% of sampled cortical area consistent with cortical necrosis (Fig. 1). She was continued with haemodialysis support and urine output and pre-dialysis serum creatinine were monitored. Her urine output after 3 months of onset of AKI is around one litre per day but her pre-dialysis serum creatinine stays in the range of 9-10 mg/dl and so she continues to receive biweekly haemodialysis. Conclusion In our index case, there was delay in getting ASV which may have contributed to development of RCN. So, early treatment of snake bite is important to prevent this catastrophic complication.

#2262 Renal outcomes of postpartum atypical hemolytic uremic syndrome treated with plasma exchange

Abstract Background and Aims Postpartum acute kidney injury (AKI) with features of thrombotic microangiopathy (TMA) are particularly challenging and complex cases. Causes include Preeclampsia (PE), hemolysis, elevated liver enzymes and low platelet count syndrome (HELLP) and atypical hemolytic uremic syndrome (aHUS). In a limited resource setting, it is difficult to diagnose such cases with more than standard blood tests. Therapeutic Plasma exchange (TPE) is the only available option for treatment in the absence of complement inhibitors. This study evaluates renal outcomes in patients with aHUS treated with plasma exchange. Method This is a single centre observational study conducted in a Tertiary Obstetric Intensive Care unit. The data of women who were admitted with postpartum AKI from January 2021 to October 2023 was retrospectively collected and analyzed. We used the following criteria to diagnose postpartum atypical HUS (Serum creatinine ≥1.9 mg/dL, Lactate dehydrogenase (LDH) ≥1832 U/L, or serum creatinine ≥1.9 mg/dL in combination with LDH ≥600 U/L) [1]. Inclusion criteria include women older than 18 yrs with microangiopathic hemolytic anaemia, schistocytes on peripheral blood film, negative direct antiglobulin test (DAT) and platelet count &amp;lt;100 /mm3.Lack of improvement of kidney functions and hemolysis 72 hours after delivery. Patients with sepsis, disseminated intravascular coagulopathy (DIC), postpartum hemorrhage (PPH) and chronic kidney disease were excluded. We identified 10 patients with postpartum aHUS. Peak creatinine, LDH, AST and Nadir platelet count and hemoglobin were recorded. Patients were followed up in the nephrology outpatient clinic. Results Fifty-two patients developed postpartum AKI in the study period. Ten patients (19%) were diagnosed with aHUS according to the above-mentioned criteria. Mean age was 24.5 ± 6.9 yrs. Median peak creatinine 5.1 (2.6-7) mg/dl, LDH 1950 (612-4000) U/L, AST 246 (150-699) U/L. Median nadir hemoglobin 7.25 (6-8.2) g/dl and platelets 57 (41-95)/mm3. All 10 patients received 3 to 6 sessions of TPE guided by platelets and LDH levels. All patients required at least 3 sessions of hemodialysis. Eight patients received TPE with plasma filter and 2 had centrifugal TPE (due to lack of plasma filters). Two patients died during ICU admission. Two months after discharge 4 (50%) patients had partial recovery of kidney functions average creatinine (3.5 ± 0.8) mg/dl and four (50%) remained dialysis dependent. Six of these patients had kidney biopsies, three biopsies showed a picture of thrombotic microangiopathy and two showed thrombotic microangiopathy with renal cortical necrosis. The other patient was lost to follow up. Conclusion It is difficult to diagnose and treat aHUS in a resource limited setting. The available treatment with therapeutic plasma exchange has poor renal outcomes.

#1799 Liver affliction among women with pregnancy-related acute kidney injury and its impact on fetal and maternal outcome

Abstract Background and Aims Pregnancy-related acute kidney injury (PR-AKI) is a worldwide health challenge that is accompanied by an increased risk of morbidity and mortality in both the mother and the fetus. PR-AKI occurs due to several causes including prerenal (hemorrhage, sepsis, hypovolemia, etc), postrenal and intrinsic renal causes (renal cortical necrosis, acute tubular necrosis, thrombotic microangiopathy [TMA], hemolysis elevated liver enzymes, low platelet count (HELLP) syndrome, preeclampsia/eclampsia, acute fatty liver of pregnancy (AFLP), glomerulonephritis [GN], etc). Hepatic affection in the context of PR-AKI may further compromise the detrimental maternal and fetal outcomes, however this seldom has been studied. Thus, this study aimed to explore the incidence of liver affliction in women with PR-AKI and to investigate its effect on the maternal and fetal outcome. Method This three-year retrospective study included women who presented to Mansoura Nephrology and Dialysis Unit with severe PR-AKI. Patients with stage I, II AKI admitted to obstetric departments were not included in the study. Patients with incomplete data were excluded from the study. The routine laboratory data and fetal and maternal outcomes were obtained from the medical records. Results The study included 77 women with PR-AKI, the mean maternal age was 28 with a minimum of 19 and maximum of 43 years. Twelve patients had hypertension while none of them had diabetes. The causes of PR-AKI are displayed in Fig. 1. Thirty-one patients (40.3%) had liver affliction. Six of them were due to HELLP, three due to underlying liver cirrhosis, one due to AFLP, the remaining cases showed abnormally elevated liver enzymes. White blood cells and INR were significantly higher among women with liver affliction than those without (P = 0.023, 0.003, respectively), while platelets were significantly lower in women with liver affliction (P = 0.002). Patients with liver affliction showed significantly higher median alanine transaminase (99 vs 27) and aspartate transaminase (103 vs 23) than those without (P &amp;lt; 0.001 for both). On the other hand, there were no statistically significant differences between patients with and without liver affliction as regard blood hemoglobin, serum creatinine, quantitative proteinuria, bicarbonate, and gestational age at termination of pregnancy. The studied women with liver affliction experienced lower percentage of renal recovery compared to those without but with no statistical significance (54.8%vs72.5%, P = 0.122). Maternal mortality was significantly more among patients with liver affliction compared to those without (32.3% vs 9.8%, P = 0.017). On the other hand, there was no significant difference between patients with and without liver affection regarding fetal outcome (live birth 55.2% vs 55.6%, P = 0.975) (Table 1). Conclusion Liver affliction is not uncommon problem among women with PR-AKI and it is associated with higher maternal mortality and lower rates of renal recovery.

A fatal misdiagnosis of page kidney - case report.

Page kidney is a condition where external compression of the renal artery and renal parenchyma leads to subsequent ischaemia and activation of renin-angiotensin-aldosterone axis. A 42-year-old female with hirsutism, hypertension and diabetes was diagnosed with a right adrenal mass and underwent laparoscopic adrenalectomy. Her hypertension worsened postoperatively and was managed medically. Subsequently she developed a right flank pain on the fifth postoperative day and died suddenly the next day. Autopsy revealed a pale body with cushingoid appearance. Surgical scars were healthy. Internal examination of the abdomen revealed a haemoperitoneum of 500ml together with a large subcapsular haematoma measuring 1000ml surrounding the right kidney, compressing the right renal artery. Kidneys were pale and the right kidney was soft and friable. Cortical surface of the right kidney demonstrated a possible surgical puncture site with an overlying thrombus together with a contused inferior vena cava. Other organs were pale but appeared otherwise normal. Histology revealed diffuse cortical necrosis of right kidney and features of adult respiratory distress syndrome in the lungs. Haemorrhagic shock following laparoscopic adrenalectomy for right adrenal tumor was declared as the cause of death, contributed by the development of the Page kidney. Trauma of several aetiologies including laparoscopic abdominal surgery may contribute to Page kidney. It presents with flank pain, hypertension and renal mass. Since postoperative blood loss usually manifests as hypotension, resulting hypertension may mislead the attending clinicians. Once diagnosed, it can be managed with surgical drainage and antihypertensives.

The kidney histopathological spectrum of patients with kidney injury following snakebite envenomation in India: scoping review of five decades

IntroductionSnakebite is a public health problem leading to about 58,000 deaths every year in India. Kidney injury subsequent to snakebite envenomation is common with a reported prevalence of up to 32%. The current study aims to elucidate the spectrum of kidney histopathology in acute kidney injury (AKI) cases associated with snake bites.MethodsWe searched seven electronic database studies to identify studies describing the histopathological findings in the kidney with snakebite envenomation. Two reviewers independently conducted titles and abstract screening as well as full-text evaluation for the final inclusion decision. Data were extracted as per the standardized form. We conducted narrative synthesis. Studies done exclusively on autopsy findings, in vitro studies, and case reports were excluded.ResultsWe retrieved 1464 studies and finally included 28 studies which met the eligibility criteria in the analysis. Most studies were single-centre and the majority were cross-sectional. Overall we included a total of 534 renal biopsies. Russell’s viper bite was the most common cause related to AKI. Acute tubular necrosis was the most common finding followed by acute interstitial nephritis, acute cortical necrosis (ACN), and thrombotic microangiopathy (TMA). Vasculitis changes in vessels were rarely reported. Lesions such as ACN and TMA were associated with poor outcomes.ConclusionThis analysis supports the notion that renal biopsies are important to guide prognosis and increase our knowledge about post-snake bite AKI pathophysiology.

Features of Postpartum Hemorrhage-Associated Thrombotic Microangiopathy and Role of Short-Term Complement Inhibition

BackgroundIn pregnancy-related atypical hemolytic uremic syndrome (p-aHUS), transferring recommendations for treatment decisions from non-pregnant cohorts with thrombotic microangiopathy (TMA) is difficult. Although potential causes of p-aHUS may be unrelated to inherent complement defects, peripartal complications such as postpartum hemorrhage or (pre)-eclampsia/HELLP-syndrome may be unrecognized drivers of complement activation. MethodsTo evaluate diagnostic and therapeutic decisions in the practical real-life setting, we conducted an analysis of a cohort of 40 patients from three German academic hospitals with a diagnosis of p-aHUS, stratified by the presence (n= 25) or absence (n=15) of postpartum hemorrhage. ResultsHistological signs of TMA were seen in 84.2% of all patients (100% versus 72.7% in patients without or with postpartum hemorrhage). Patients without postpartum hemorrhage had a higher likelihood (20 % versus 0 %) of pathogenic genetic abnormalities in the complement system although notably less than in other published cohorts. Four out of five patients with seen renal cortical necrosis after postpartum hemorrhage received complement inhibition and partially recovered kidney function. Patients on complement inhibition with or without postpartum hemorrhage had an increased need for kidney replacement therapy and plasma exchange. Since renal recovery was comparable among all patients treated with complement inhibition, a potential beneficial effect in this group of pregnancy-associated thrombotic microangiopathies and p-aHUS is presumed. ConclusionsBased on our findings, we suggest a pragmatic approach towards limited and short-term anti-complement therapy for patients with the clinical diagnosis of p-aHUS, which should be stopped once causes of TMA other than genetic complement abnormalities emerge.

Renal Cortical Necrosis Complicating Postpartum Hemorrhage. Use of Tranexamic Acid: Solution or Problem? Case Report

Renal cortical necrosis associated with postpartum hemorrhage is a rare obstetric complication that can lead to end-stage renal disease. We report a case of a 37-year-old woman, admitted for preeclampsia complicated by in utero fetal death, having presented postpartum hemorrhage complicated by a retroplacental hematoma (RPH). She was treated with tranexamic acid to control bleeding. She subsequently presented a severe acute kidney injury (AKI) requiring hemodialysis with, on computed tomography (CT), the presence of bilateral renal cortical necrosis. A renal biopsy showed cortical necrosis lesions associated with glomerular and vascular thrombotic microangiopathy. There was no recovery of renal function, requiring long-term hemodialysis. Renal cortical necrosis, although rare, can occur in some cases of postpartum hemorrhage. Tranexamic acid would be involved and its use should be done with suspicion. The CT scan is an important diagnostic tool. Renal prognosis is poor.

Plasmodium vivax Malaria Presenting as TMA and Acute Cortical Necrosis: A Case Series.

Plasmodium vivax Malaria Presenting as TMA and Acute Cortical Necrosis: A Case Series.

Bilateral Renal Cortical Necrosis and Reversible Cerebral Vasoconstriction Syndrome in a Case of Severe Postpartum Haemorrhage

Bilateral Renal Cortical Necrosis (BRCN) is a rare but serious condition characterised by the ischaemic necrosis of both kidneys’ cortical tissues. Concurrently, Reversible Cerebral Vasoconstriction Syndrome (RCVS) manifests as a transient constriction of cerebral blood vessels. The fusion of these two rare entities within the context of severe Postpartum Haemorrhage (PPH) poses a unique diagnostic and therapeutic dilemma for healthcare practitioners. This case study documents the intricate and severe complications experienced by a 32-year-old primiparous woman following abruptio placenta with Intrauterine Foetal Death (IUFD). The patient presented with massive vaginal bleeding, leading to an emergency Lower Segment Caesarean Section (LSCS) where bilateral uterine artery ligation and bilateral internal iliac artery ligation were performed to control haemorrhage. Despite initial interventions, the patient’s condition deteriorated, leading to signs of shock, haemoperitoneum, sepsis, Acute Kidney Injury (AKI), and cerebral complications. The medical journey unfolded with an urgent re-laparotomy, draining haemoperitoneum and conducting a subtotal hysterectomy. This case highlights the critical importance of a multidisciplinary approach involving obstetrics, nephrology, and intensive care, in managing such complex postpartum complications. Vigilant monitoring, collaborative decision-making, and meticulous postoperative care played pivotal roles. The successful outcome was attributed to early recognition, aggressive supportive measures, and timely interventions, including haemodialysis. The challenges faced underscore the need for accessible obstetric care, awareness about antenatal complications, and community-focused initiatives. Further research is warranted to unravel the intricate connections between PPH, RCVS, and associated complications, enhancing our understanding and improving patient outcomes in similar critical cases.

Quantitative cistern effacement and reduced gray to white matter ratio for prognostication in early brain computed tomography of patients with cardiac arrest

BackgroundThe impact of cerebral edema on brain cells and ventricles in cardiac arrest patients can manifest as effacement of cortical sulci, diminished ventricle size, altered gray matter to white matter ratio (GWR), and increased optic nerve sheath diameter (ONSD) in brain CT scans. However, a complete investigation of GWR in whole lobes, quantitative cistern size, and comprehensive comparison of various brain CT parameters has not been conducted. This study aimed to comprehensively compare various early brain CT parameters along with conventional significant variables in relation to poor neurological outcome and diffuse cortical necrosis. MethodsThis retrospective study included 86 adult patients with cardiac arrest who underwent brain CT/MRI. GWRs, the distance of the posterior ambient cistern, and ONSD in early brain CT and regions of interest (ROIs) in brain MRI were measured and analyzed along with clinical characteristics. ResultsROIs in the putamen and parietal white matter showed significant differences (p = 0.05, p = 0.022, respectively). The distance of the posterior ambient cistern and the GWR of the putamen and parietal white matter were newly developed predictors that were not used previously and demonstrated a significant correlation with the presence of diffuse cortical necrosis (OR 0.4, p = 0.006, AUC 0.637; OR 0.478, p = 0.02, AUC 0.603, respectively) or poor neurological outcomes (AUC 0.637, AUC 0.603, respectively), but were not more significant than pupil reflex (OR 0.06, p < 0.001). ONSD was not significantly associated with the outcomes. ConclusionsQuantitative cistern effacement and reduced GWR of the putamen and parietal white matter in early brain CT measurements of cardiac arrest patients were promising predictors in early brain CT for prognostication, but compared with clinical characteristics, the clinical significance of the CT predictors was not considerable. The relationship and clinical significance between the parameters in early brain CT and the outcomes might have to be separately considered.

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.

Renal Cortical Necrosis in Sickle Cell Trait

Renal Cortical Necrosis in Sickle Cell Trait

#3404 UTILITY OF RENAL BIOPSY IN THE ETIOLOGY, MANAGEMENT AND OUTCOME OF POSTPARTUM ACUTE KIDNEY INJURY

Abstract Background and Aims Acute kidney injury (AKI) is a serious complication during pregnancy and postpartum period resulting in significant maternal morbidity, mortality and fetal loss. Pregnancy related acute kidney injury is still more prevalent in developing countries. This study aims to evaluate renal biopsies in postpartum period AKI (PPAKI) with etiology and its management and outcome. Method Retrospective analysis of 83 native renal biopsies received in the department of pathology, SGPGIMS, Lucknow, a tertiary care center in India with PPAKI from January 2007 to December 2021 were analyzed. Clinical and laboratory data were retrieved and renal biopsy histology slides were reviewed. Results Eighty-three patients with mean age 27.5±4.6 years had biopsy proven PPAKI. Cesarian section, vaginal delivery, hysterectomy and abortion were performed in 51, 19, 2 and 11 patients respectively. The cause of AKI was sepsis (38.6%), postpartum hemorrhage (26.5%), thrombotic microangiopathy (TMA) (11%), pre-eclampsia (3.7%) and other (20%). Duration of onset of AKI after delivery/abortion ranged from 0 to 30 days (mean 4.5±6.3 days). Fetal loss was seen in 31.7% patients. Biopsy showed partial/complete renal cortical necrosis (56.6%), TMA (24.1%), acute tubular injury (ATI) (4.8%), Lupus nephritis flare in 3.6% and other glomerular diseases (8.4%) and Tubulointerstitial nephritis in (1.2%) patient. All received multiple sessions of haemodialysis and 10 patients also had plasmapheresis. During hospital stay one died due to sepsis and shock, remainder were discharged in a stable condition with complete recovery in (5), partially recovery in (7); and 61 (71%) patients required continued renal replacement therapy. Two patients died and two had subsequent live related renal transplantation on available follow-up. Conclusion AKI is a serious complication in postpartum period and require early and prompt attention to reduce fetal and maternal morbidity. Sepsis is the commonest cause of postpartum AKI

Clinical presentation, diagnosis, treatment, and outcome in 8 dogs and 2 cats with global hypoxic-ischemic brain injury (2010-2022).

Global hypoxic-ischemic brain injury (GHIBI) results in variable degrees of neurological dysfunction. Limited data exists to guide prognostication on likelihood of functional recovery. Prolonged duration of hypoxic-ischemic insult and absence of neurological improvement in the first 72 hours are negative prognostic indicators. Ten clinical cases with GHIBI. Retrospective case series describing 8 dogs and 2 cats with GHIBI, including clinical signs, treatment, and outcome. Six dogs and 2 cats experienced cardiopulmonary arrest or anesthetic complication in a veterinary hospital and were promptly resuscitated. Seven showed progressive neurological improvement within 72 hours of the hypoxic-ischemic insult. Four fully recovered and 3 had residual neurological deficits. One dog presented comatose after resuscitation at the primary care practice. Magnetic resonance imaging confirmed diffuse cerebral cortical swelling and severe brainstem compression and the dog was euthanized. Two dogs suffered out-of-hospital cardiopulmonary arrest, secondary to a road traffic accident in 1 and laryngeal obstruction in the other. The first dog was euthanized after MRI that identified diffuse cerebral cortical swelling with severe brainstem compression. In the other dog, spontaneous circulation was recovered after 22 minutes of cardiopulmonary resuscitation. However, the dog remained blind, disorientated, and ambulatory tetraparetic with vestibular ataxia and was euthanized 58 days after presentation. Histopathological examination of the brain confirmed severe diffuse cerebral and cerebellar cortical necrosis. Duration of hypoxic-ischemic insult, diffuse brainstem involvement, MRI features, and rate of neurological recovery could provide indications of the likelihood of functional recovery after GHIBI.