Postoperative renal cortical necrosis in a patient with contralateral remnant kidney

A 58-year-old woman was referred to nephrology department because acute kidney injury had developed after left hemicolectomy and partial ureterectomy due to left ureterocolic fistula with ureteral stone. She had a history of left partial nephrectomy because of traumatic renal injury thirty seven years ago. Her baseline serum creatinine level was 0.9mg/dL. Two days after the operation, serum creatinine level had increased to 2.1mg/dL with oliguria. Contrast-enhanced abdominal computed tomography (CT) showed decreased perfusion in right renal cortex sparing medulla, which is the characteristic finding of renal cortical necrosis (Figure-1). Her renal function did not recover although emergency hemodialysis with conservative management was performed. She has undergone maintenance hemodialysis.

Figure 1
Axial (A) and coronal scan (B) of contrast-enhanced abdominal computed tomography showed non-enhancement of cortex but enhancement of medulla in right kidney, which is the characteristic finding of renal cortical necrosis.

Renal cortical necrosis is a rare cause of acute kidney injury, which is caused by decreased renal arterial perfusion. Obstetric complications remain the leading cause of renal cortical necrosis (¹). Non-obstetric causes such as sepsis, hemolytic uremic syndrome and operative procedures are also important causes (²). Contrast-enhanced CT is the useful diagnostic tool although definitive diagnosis is made by renal biopsy (³). It has been suggested that characteristic CT finding is attributed to the selective involvement of interlobular and afferent arterioles (⁴). Untreated patients have high mortality, and early dialysis is important to improving clinical outcomes (⁵).

REFERENCES

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  Kim HJ, Cho OK: CT scan as an important diagnostic tool in the initial phase of diffuse bilateral renal cortical necrosis. Clin Nephrol. 1996; 45: 125-30.
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  Prakash J, Vohra R, Wani IA, Murthy AS, Srivastva PK, Tripathi K, et al.: Decreasing incidence of renal cortical necrosis in patients with acute renal failure in developing countries: a single-centre experience of 22 years from Eastern India. Nephrol Dial Transplant. 2007; 22: 1213-7.

Publication Dates

• Publication in this collection
  may-jun 2014

History

• Received
  06 Aug 2013
• Accepted
  09 Jan 2014