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.
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 (11 .Kim HJ: Bilateral renal cortical necrosis with the changes in clinical features over the past 15 years (1980-1995). J Korean Med Sci. 1995; 10: 132-41.). Non-obstetric causes such as sepsis, hemolytic uremic syndrome and operative procedures are also important causes (22 .Hida M, Saitoh H, Satoh T: Autopsy findings in postoperative acute renal failure patients, collected from the annuals of pathological autopsy cases in Japan. Tokai J Exp Clin Med. 1984; 9: 349-55.). Contrast-enhanced CT is the useful diagnostic tool although definitive diagnosis is made by renal biopsy (33 .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.). It has been suggested that characteristic CT finding is attributed to the selective involvement of interlobular and afferent arterioles (44 .Deutsch V, Frankl O, Drory Y, Eliahou H, Braf ZF: Bilateral renal cortical necrosis with survival through the acute phase with a note on the value of selective nephroangiography. Am J Med. 1971; 50: 828-34.). Untreated patients have high mortality, and early dialysis is important to improving clinical outcomes (55 .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.).
REFERENCES
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1Kim HJ: Bilateral renal cortical necrosis with the changes in clinical features over the past 15 years (1980-1995). J Korean Med Sci. 1995; 10: 132-41.
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2Hida M, Saitoh H, Satoh T: Autopsy findings in postoperative acute renal failure patients, collected from the annuals of pathological autopsy cases in Japan. Tokai J Exp Clin Med. 1984; 9: 349-55.
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3Kim 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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4Deutsch V, Frankl O, Drory Y, Eliahou H, Braf ZF: Bilateral renal cortical necrosis with survival through the acute phase with a note on the value of selective nephroangiography. Am J Med. 1971; 50: 828-34.
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5Prakash 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
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Publication in this collection
may-jun 2014
History
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Received
06 Aug 2013 -
Accepted
09 Jan 2014