Bilateral Renal Cortical Necrosis Research Articles

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.

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.

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.

Acute Renal Failure in Pregnancy: A Prospective Cohort Study

Introduction: Pregnancy-related acute renal failure is a common occurrence and is associated with substantial maternal morbidity and mortality in developing countries. It may comprise up to 25% of the referrals to dialysis centres in developing countries. Acute kidney injury in pregnancy bears a high risk of bilateral renal cortical necrosis and resultant chronic renal failure. Acute renal failure in pregnancy follows bimodal relation to period of gestation. First peak is seen in early pregnancy between 7-16 weeks of gestation and second peak occurs in later part of pregnancy and puerperium. The incidence and aetiology are changing over time. Socio-economic and environmental factors are accountable for a regional difference in incidence, aetiology and outcome also. Aim: To analyse the current aetiological factors, clinical spectrum of presentation of Acute Renal Failure (ARF) in pregnancy and to assess its maternal and foetal outcome. Materials and Methods: It was a prospective cohort study of 100 patients presenting with acute renal failure during pregnancy and puerperium which was done at SCB Medical College, Odisha, India. Inclusion criteria were previously healthy pregnant females with sudden oliguria anuria, sudden increase in serum creatinine to more than 1.5 mg/dL or increase in serum creatinine of more than 0.5 mg/dL per day from base line if haemodialysis was indicated. Maternal outcomes were recovery with conservative treatment, dialysis, ICU admission and maternal death. Foetal outcomes were gestational age at delivery, birth weight, stillbirth or perinatal death. All these were recorded. Results: During the first trimester of gestation acute renal failure developed most often due to septic abortion (3%). Preclampsia was the most common cause of acute renal failure (50%) in late third trimester and postpartum periods followed by puerperal sepsis (9%) Abruptio placentae (3%) and Postpartum Haemorrhage (PPH) (5%). Oedema and oliguria were the most common presentation in 81% and 30% of cases. Eighty seven percent recovered with i.v. fluids and diuretics (conservative management), 13% required dialysis, 23% required blood and Fresh Frozen Plasma (FFP), 30% needed ICU admission and 11% died during treatment. Foetal outcome were measured in terms of foetal growth restriction (24%), preterm delivery (14%), foetal distress (13%), SNCU admission (23%) and stillbirth (5%). Conclusion: This study concludes that pregnancy related acute renal failure is associated with serious prognosis both for the mother and child. Even though good obstetric care can reduce morbidity and mortality associated with it, these patients require special and intensive care management facility which can bring them better survival rates.

Bilateral acute renal cortical necrosis after a dog bite: case report

BackgroundCapnocytophaga canimorsus is a Gram-negative capnophilic rod and part of dogs/cats’ normal oral flora. It can be transmitted by bites, scratches, or even by contact of saliva with injured skin. Asplenic patients and patients with alcohol abuse are at particular risk for fulminant C. canimorsus sepsis. However, also immunocompetent patients can have a severe or even fatal infection. This is the first case of a severe C. canimorsus infection in an immunocompromised host complicated by acute renal cortical necrosis with a “reverse rim sign” in contrast-enhanced computed tomography on hospital admission.Case presentationWe report the case of a 44-year functionally asplenic patient after an allogeneic stem cell transplantation, who presented with septic shock after a minor dog bite injury 4 days prior. Because of abdominal complaints, epigastric pain with local peritonism, and radiological gallbladder wall thickening, an abdominal focus was suspected after the initial work-up. The patient underwent emergent open cholecystectomy, but the clinical suspicion of abdominal infection was not confirmed. Septic shock was further complicated by cardiomyopathy and disseminated intravascular coagulation. As a causative pathogen, C. canimorsus could be isolated. The clinical course was complicated by permanent hemodialysis and extensive acral necrosis requiring amputation of several fingers and both thighs.ConclusionWe present a severe case of a C. canimorsus infection in a functionally asplenic patient after a minor dog bite. The clinical course was complicated by septic shock, disseminated intravascular coagulation, and the need for multiple amputations. In addition, the rare form of acute renal failure - bilateral acute renal cortical necrosis – was visible as “reverse rim sign” on computed tomography scan. This case is an example of the potential disastrous consequences when omitting pre-emptive antibiotic therapy in wounds inflicted by cats and dogs, particularly in asplenic patients.

Sonographic Rim in Acute Renal Cortical Necrosis

Ultrasonography is the first line of investigation requested for patients presenting with a clinical features of acute renal failure. Acute renal Cortical Necrosis (ACN) is an uncommon cause of acute renal failure secondary to reduced perfusion to the renal cortex with relative sparing of the medulla. There is limited literature available on early sonographic features of acute cortical necrosis. Ultrasonography finding of hypoechoic renal cortex is a diagnostic feature of acute cortical necrosis. This appearance can be aptly called "Sonographic hypoechoic cortical rim". Bilateral ACN following pancreatitis is an extremely rare entity. Due to rarity of association between pancreatitis and bilateral renal cortical necrosis, authors reported case of 25-year-old male presented with severe abdominal pain, vomiting, reduced urine output, constipation. Ultrasonography revealed normal size kidneys with diffuse circumferential hypoechoic appearance of cortex on both sides. Laboratory investigations demonstrated elevated white blood cell count, raised serum amylase. Diagnosis of ACN secondary to acute pancreatitis was made.

INTRAVASCULAR ACTIVATION OF THE CLOTTING SYSTEM WITH PHOSPHOLIPIDS. PRODUCTION OF THE GENERALIZED SHWARTZMAN REACTION WITH PLATELET FACTOR 3.

Shwartzman reaction (GSR )-is observed in rabbits after two properly spaced intravenous injections of endotoxin derived from gram-negative bacteria and is characterized by profound collapse and hemorrhagic diathesis. Marked changes in the blood clotting mechanism in animals undergoing GSR have been described’6’30’35 and resemble those observed when blood clots in vitro. The platelets which remain in the circulation of these animals are altered both in number and in their specific procoagulant effects; the activities of both platelet factor 1 (adsorbed Ac-G) and of platelet factor 3 (phospholipid) are greatly impaired.�’36 Morphologically, the reaction is characterized by a generalized intravascular deposition of fibnin. Bilateral renal cortical necrosis with fibnin-thrombi in the glomerular capillaries is observed in animals that survive long enough to develop this lesion. The present work deals with the morphologic and coagulative changes produced by infusing phospholipid having platelet factor 3 activity, or soya bean phospholipid (Inosithin), in rabbits previously given intravenous thorotrast with the intent of blocking the reticuloendothelial system. The alterations described were indistinguishable from those observed in the classical GSR produced in rabbits with two intravenous injections of endotoxin.

Murine Typhus-Related Thrombotic Microangiopathy, Bilateral Renal Cortical Necrosis, and Acute Disseminated Encephalomyelitis

Murine Typhus-Related Thrombotic Microangiopathy, Bilateral Renal Cortical Necrosis, and Acute Disseminated Encephalomyelitis

Acute Severe Pancreatitis and Bilateral Renal Cortical Necrosis

Acute Severe Pancreatitis and Bilateral Renal Cortical Necrosis

Tranexemic acid induced bilateral acute renal cortical necrosis

Acute renal cortical necrosis (RCN) most commonly occurs from obstetric complications. However other rare cause includes medications like antifibrinolytics like tranexamic acid, which is used for acute bleeding. We report a case of 17 years female, operated for left cheek arteriovenous malformation and managed post-operatively by intravenous fluids, diuretics, antibiotics and antifibrinolytics (tranexemic acid). Postoperatively she started complaining of severe abdominal pain, breathlessness, weakness and loss of orientation with increasing levels of serum creatinine and blood urea nitrogen (BUN). Patient succumbed to death on day 6 post operative and complete autopsy was performed. All organs were unremarkable except bilateral lungs showed pulmonary edema and bilateral kidneys showed features of diffuse pattern of cortical necrosis both on gross and histopathological examination. As patient had no obstetric or other related history the cause of RCN was attributed to tranexemic acid. Thus patients on antifibrinolytics must be screened for RCN to avoid its fatal complication.

Bilateral Renal Cortical Necrosis in a Case of Granulomatosis with Polyangitis.

Bilateral Renal Cortical Necrosis in a Case of Granulomatosis with Polyangitis.

両側腎皮質壊死の病理 : 妊娠・分娩が関与しない本症 2 剖検例の報告特にその発生機序についての考察

両側腎皮質壊死の病理 : 妊娠・分娩が関与しない本症 2 剖検例の報告特にその発生機序についての考察

Bilateral renal cortical necrosis following abdominal surgery

A 58-year-old patient developed complete anuria following elective abdominal surgery for an ileocaecal mass. Contrast-enhanced computed tomography demonstrated absent intra-renal blood flow and a kidney biopsy confirmed diffuse cortical necrosis. Histology of the ileocaecal mas displayed deep fissuring which was diagnostic of Crohn’s disease. Bilateral renal cortical necrosis (BRCN) is a rare complication of surgery but should be considered in any patient developing complete anuria. Since the disease is often associated with a coagulopathy, conditions predisposing to thrombosis should be sought. Inflammatory Bowel Disease (IBD) with surgical complications, as in this case, should be considered among the conditions which may predispose to BRCN.

Bilateral renal cortical necrosis in a patient undergoing in vitro fertilization.

Bilateral renal cortical necrosis in a patient undergoing in vitro fertilization.

Pathogenesis of disseminated intravascular coagulation.

Figure 5 summarizes the three different phases in the pathophysiology of disseminated intravascular coagulation exemplified by the effect of endotoxin. During the first phase, the coagulation system is activated to generate soluble fibrin. Fibrin kept in solution by fibrinogen or fibrinolytic degradation products can be cleared from the circulating blood. If the amount of soluble fibrin exceeds a certain threshold, soluble fibrin may precipitate or polymerize to fibrin clots. At this state, active fibrinolysis breaks down the precipitated fibrin to fibrinolytic degradation products preventing the preservation of fibrin. If the capacity of the fibrinolytic system is exhausted, or if fibrinolysis is inhibited, fibrin clots may be preserved, causing cell damage, as for instance bilateral renal cortical necrosis.

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

Quiz Page June 2014: A 45-Year-Old Woman With Acute Anuria

Quiz Page June 2014: A 45-Year-Old Woman With Acute Anuria

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.

Contrast enhanced ultrasound (CEUS) in the diagnosis of post-partum bilateral renal cortical necrosis: a case report and review of the literature

Renal cortical necrosis is a rare condition with complex pathogenesis. There is no consensus over the best investigative modality for an initial diagnosis that is often in the context of acute renal failure. The applications of ultrasound contrast are ever growing, particularly with regard to the assessment of abdominal organs. Here, we present a case of post-partum bilateral renal cortical necrosis affecting bilateral native kidneys and the subsequent use of contrast enhanced ultrasound in confirming this diagnosis. The sonographic appearance was found to correlate with the patients' clinical presentation and other imaging findings. Secondarily, this allowed for appropriate and timely medical management and establishes the utility of ultrasound contrast in this clinical scenario. Contrast enhanced sonographic assessment should be considered early in patients with suspected renal vascular compromise. It is a safe, easy and efficacious investigative modality to stratify those patients with renal cortical necrosis from those with potentially reversible medical causes.