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Jiang L, Wang S, Tan Y, Su T. Postpartum Renal Cortical Necrosis: A Case Series. Kidney Med 2024; 6:100892. [PMID: 39314861 PMCID: PMC11417324 DOI: 10.1016/j.xkme.2024.100892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024] Open
Abstract
Rationale & Objective Postpartum renal cortical necrosis (postpartum RCN) is a severe form of obstetric acute kidney injury. This study aimed to identify clinicopathologic features in Chinese postpartum RCN cases to determine how pathologic findings may contribute to the treatment and prognosis. Study Design Single-center, case series. Setting & Participants Twelve 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 magnetic resonance imaging or pathologic features. Clinical, laboratory, and pathologic data were compared between patients with estimated glomerular filtration rate <30 (poor outcome) and ≥30 mL/min/1.73 m2 after 6 months. Observations All patients with postpartum RCN presented with stage 3 acute kidney injury attributed to a probable atypical hemolytic uremic syndrome. Pregnancy terminations occurred at a median gestational age of 35.5 weeks. Kidney biopsy was performed from 18 days to 4 months from delivery. On biopsy, hemoglobin, platelet count, and lactate dehydrogenase 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 "not otherwise specified" 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. Limitations Limited sample size and retrospective design. Conclusions We identified key pathologic features in patients with postpartum RCN and atypical hemolytic uremic syndrome, highlighting the necessity for more effective therapeutic options. There is a clear demand for noninvasive biomarkers that can accurately track disease progression and inform treatment duration for long-term outcomes improvement.
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Affiliation(s)
- Lei Jiang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Renal Pathology Center, Institute of Nephrology, Peking University, Beijing, China
| | - Suxia Wang
- Renal Pathology Center, Institute of Nephrology, Peking University, Beijing, China
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, China
| | - Ying Tan
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Renal Pathology Center, Institute of Nephrology, Peking University, Beijing, China
| | - Tao Su
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Renal Pathology Center, Institute of Nephrology, Peking University, Beijing, China
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Wang R, Liu X, Li W, Tan Y, Qiu J, Su T. Pregnancy-Associated Renal Cortical Necrosis and Nonenhanced Functional MRI: A Case Series. Kidney Med 2023; 5:100623. [PMID: 37122390 PMCID: PMC10131107 DOI: 10.1016/j.xkme.2023.100623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Rationale & Objective Pregnancy-associated renal cortical necrosis is a critical illness with a poor prognosis. We aimed to describe the clinical and magnetic resonance imaging (MRI) characteristics of a case series of patients with acute kidney injury in the setting of pregnancy-associated renal cortical necrosis. Study Design Case series. Setting & Participants Seventeen patients from a single center diagnosed by nonenhanced functional MRI and/or kidney pathology. Results All patients presented with postpartum acute kidney injury stage 3. Of the 17 patients, 15 (88%) had pregnancy-associated atypical hemolytic uremic syndrome, 11 (65%) had postpartum hemorrhage, 7 (41%) had preeclampsia/hemolysis elevated liver enzymes low platelet count syndrome, and 4 (24%) had disseminated intravascular coagulation. On T2-weighted MRI, the diffuse phenotype showed outer cortex swelling in the early phase, with a dark signal rim involving the inner cortex and Bertin column, which became more apparent over time along with cortical thinning, substantially decreasing T2 signal intensity. The focal phenotype showed focally distributed hypointense signals in the cortex. After 8-101 (median: 60) months of follow-up, 4 individuals had estimated glomerular filtration rates ≥60 mL/min/1.73 m2, 6 had estimated glomerular filtration rates of 15-60 mL/min/1.73 m2, and 7 had kidney failure requiring kidney replacement therapy. The diffuse phenotype was present in all of the individuals who remained kidney replacement therapy dependent. Limitations Retrospective study; small sample size. Conclusions Different forms of pregnancy-associated thrombotic microangiopathy were the major causative diseases in our pregnancy-associated renal cortical necrosis case series. Nonenhanced functional MRI may provide valuable data for establishing diagnosis and kidney prognosis.
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Jaynul Islam SM, Akhter S, Hossain MS. Renal Cortical Necrosis; Five Consecutive Cases within Short Span of Time. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2019; 30:919-923. [PMID: 31464250 DOI: 10.4103/1319-2442.265469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Renal cortical necrosis (RCN) is characterized by patchy or diffuse destruction of all the elements of renal cortex resulting from significantly diminished renal arterial perfusion due to vascular spasm and microvascular injury. It is a rare cause of acute kidney injury (AKI) in developed countries with frequency of 1.9%-2% of all patients of AKI. In contrast, the incidence of RCN is higher in developing countries ranging from 6%-7%. Obstetric complication is the main cause of RCN, earlier it was about 20%-30% which has been declining to 5% in the Indian subcontinent during the past two decades. The aim of this study is to review five consecutive cases of RCN diagnosed within very short span of time. Histopathologically, diagnosed five cases of RCN during one-month span in September 2016 at Armed Forces Institute of Pathology, Dhaka were included in this study. All the cases were referred cases from a tertiary level obstetric center of Dhaka city; the mean age was 24.2 ± 3.4 years. All the cases had the history of postpartum hemorrhage followed by septicemia. They all presented with acute renal failure dependent on hemodialysis for >21 days. On histological examination, three (60%) had patchy RCN and two (40%) had diffuse RCN. Two (40%) showed coagulative necrosis of all the glomeruli, two (40%) showed coagulative necrosis of >50% of glomeruli, and in one (20%) case necrosis of about 25% of glomeruli. One of the glomeruli showed global sclerotic change of most of the glomeruli. In all the cases, interstitium showed moderate focal lymphocytic infiltration and mild edema. Among all, one (20%) was found with immunoglobulin A nephropathy as an associated diagnosis. RCN is still encountered as an obstetric complication in our setting and this type of grave consequences should be prevented by better monitoring of pregnancies.
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Affiliation(s)
| | - Selina Akhter
- Department of Histopathology, Armed Forces Institute of Pathology, Dhaka, Bangladesh
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Ko DH, Kim TH, Kim JW, Gu JJ, Yoon BH, Oh JH, Hong SG. Tranexamic Acid-Induced Acute Renal Cortical Necrosis in Post-Endoscopic Papillectomy Bleeding. Clin Endosc 2017; 50:609-613. [PMID: 28793394 PMCID: PMC5719915 DOI: 10.5946/ce.2017.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 05/18/2017] [Accepted: 05/29/2017] [Indexed: 11/14/2022] Open
Abstract
Acute renal failure can be the result of acute renal cortical necrosis (RCN), which commonly occurs from complications occurring during pregnancy. RCN is rarely caused by medications, although tranexamic acid, which is used in patients with acute bleeding for its antifibrinolytic effects, reportedly causes acute RCN in rare cases. An 82-year-old woman experienced gastrointestinal bleeding after endoscopic papillectomy of an ampullary adenoma. The bleeding was controlled with tranexamic acid administration; however, 4 days later, her urine volume decreased and she developed pulmonary edema and dyspnea. Serum creatinine levels increased from 0.8 to 3.9 mg/dL and dialysis was performed. Abdominal pelvic computed tomography with contrast enhancement revealed bilateral RCN with no renal cortex enhancement. Renal dysfunction and oliguria persisted and hemodialysis was continued. Clinicians must be aware that acute RCN can occur after tranexamic acid administration to control bleeding.
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Affiliation(s)
- Doo Hyun Ko
- Department of Internal Medicine, SAM Anyang Hospital, Anyang, Korea
| | - Tae Hyung Kim
- Department of Internal Medicine, SAM Anyang Hospital, Anyang, Korea
| | - Jong Wook Kim
- Department of Internal Medicine, SAM Anyang Hospital, Anyang, Korea
| | - Ja Joong Gu
- Department of Internal Medicine, SAM Anyang Hospital, Anyang, Korea
| | - Baek Hyun Yoon
- Department of Internal Medicine, SAM Anyang Hospital, Anyang, Korea
| | - Ji Hong Oh
- Department of Internal Medicine, SAM Anyang Hospital, Anyang, Korea
| | - Seung Goun Hong
- Department of Internal Medicine, SAM Anyang Hospital, Anyang, Korea
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Frimat M, Decambron M, Lebas C, Moktefi A, Lemaitre L, Gnemmi V, Sautenet B, Glowacki F, Subtil D, Jourdain M, Rigouzzo A, Brocheriou I, Halimi JM, Rondeau E, Noel C, Provôt F, Hertig A. Renal Cortical Necrosis in Postpartum Hemorrhage: A Case Series. Am J Kidney Dis 2016; 68:50-7. [DOI: 10.1053/j.ajkd.2015.11.022] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 11/29/2015] [Indexed: 11/11/2022]
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Arenillas C, Villa P, Rogero S, Luján J, Velo M, Cambronero JA. Bilateral acute cortical necrosis and severe acute pancreatitis. Med Intensiva 2016; 40:383-4. [PMID: 26725568 DOI: 10.1016/j.medin.2015.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 10/22/2015] [Accepted: 10/29/2015] [Indexed: 11/26/2022]
Affiliation(s)
- C Arenillas
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - P Villa
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
| | - S Rogero
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - J Luján
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - M Velo
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - J A Cambronero
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
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Prakash J, Singh VP. Changing picture of renal cortical necrosis in acute kidney injury in developing country. World J Nephrol 2015; 4:480-486. [PMID: 26558184 PMCID: PMC4635367 DOI: 10.5527/wjn.v4.i5.480] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/19/2015] [Accepted: 10/19/2015] [Indexed: 02/06/2023] Open
Abstract
Renal cortical necrosis (RCN) is characterized by patchy or diffuse ischemic destruction of all the elements of renal cortex resulting from significantly diminished renal arterial perfusion due to vascular spasm and microvascular injury. In addition, direct endothelial injury particularly in setting of sepsis, eclampsia, haemolytic uremic syndrome (HUS) and snake bite may lead to endovascular thrombosis with subsequent renal ischemia. Progression to end stage renal disease is a rule in diffuse cortical necrosis. It is a rare cause of acute kidney injury (AKI) in developed countries with frequency of 1.9%-2% of all patients with AKI. In contrast, RCN incidence is higher in developing countries ranging between 6%-7% of all causes of AKI. Obstetric complications (septic abortion, puerperal sepsis, abruptio placentae, postpartum haemorrhage and eclampsia) are the main (60%-70%) causes of RCN in developing countries. The remaining 30%-40% cases of RCN are caused by non-obstetrical causes, mostly due to sepsis and HUS. The incidence of RCN ranges from 10% to 30% of all cases of obstetric AKI compared with only 5% in non-gravid patients. In the developed countries, RCN accounts for 2% of all cases of AKI in adults and more than 20% of AKI during the third trimester of pregnancy. The reported incidence of RCN in obstetrical AKI varies between 18%-42.8% in different Indian studies. However, the overall incidence of RCN in pregnancy related AKI has decreased from 20%-30% to 5% in the past two decades in India. Currently RCN accounts for 3% of all causes of AKI. The incidence of RCN in obstetrical AKI was 1.44% in our recent study. HUS is most common cause of RCN in non-obstetrical group, while puerperal sepsis is leading cause of RCN in obstetric group. Because of the catastrophic sequelae of RCN, its prevention and aggressive management should always be important for the better renal outcome and prognosis of the patients.
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Ma SK, Kim SW. Postoperative renal cortical necrosis in a patient with contralateral remnant kidney. Int Braz J Urol 2014; 40:429-30. [DOI: 10.1590/s1677-5538.ibju.2014.03.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 01/09/2014] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Soo Wan Kim
- Chonnam National University Medical School, Korea
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Prakash J, Srivastava A, Singh S, Ghosh B. Renal cortical necrosis in a live kidney donor. Indian J Nephrol 2012; 22:48-51. [PMID: 22279344 PMCID: PMC3263064 DOI: 10.4103/0971-4065.83747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Renal cortical necrosis (RCN) is a rare cause of acute renal failure (ARF). There is no clinical case report of RCN in a live kidney donor. A 48-year-old female kidney donor developed sudden anuria five hours postnephrectomy and remained anuric for more than three months on maintenance hemodialysis. Laboratory investigations revealed the features of hemolytic uremic syndrome. Contrast-enhanced computed tomography scan of abdomen showed hypoattenuated subcapsular rim of renal cortex favoring diagnosis of RCN. To the best of our knowledge, this is the first clinical case report of RCN in a live kidney donor in world literature.
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Affiliation(s)
- J Prakash
- Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Prakash J, Srivastava A, Singh S, Ghosh B. Renal cortical necrosis in a live kidney donor. Indian J Nephrol 2012. [PMID: 22279344 DOI: 10.4103/097-4065.83747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Renal cortical necrosis (RCN) is a rare cause of acute renal failure (ARF). There is no clinical case report of RCN in a live kidney donor. A 48-year-old female kidney donor developed sudden anuria five hours postnephrectomy and remained anuric for more than three months on maintenance hemodialysis. Laboratory investigations revealed the features of hemolytic uremic syndrome. Contrast-enhanced computed tomography scan of abdomen showed hypoattenuated subcapsular rim of renal cortex favoring diagnosis of RCN. To the best of our knowledge, this is the first clinical case report of RCN in a live kidney donor in world literature.
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Affiliation(s)
- J Prakash
- Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Jung YS, Shin HS, Rim H, Jang K, Park MH, Park JS, Lee CH, Kim GH, Kang CM. Bilateral Renal Cortical Necrosis Following Binge Drinking. Alcohol Alcohol 2012; 47:140-2. [DOI: 10.1093/alcalc/agr154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kim JO, Kim GH, Kang CM, Park JS. Bilateral Acute Renal Cortical Necrosis in SLE-Associated Antiphospholipid Syndrome. Am J Kidney Dis 2011; 57:945-7. [DOI: 10.1053/j.ajkd.2011.02.381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 02/16/2011] [Indexed: 11/11/2022]
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13
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Affiliation(s)
- Lesley Archer
- Department of Radiology, Southmead Hospital, Bristol BS10 5NB, UK.
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Martín Cuartero J, Angulo Hervias E, Abril Avellanas E, Larrosa López R. Mujer con hipotensión y fallo renal agudo. Rev Clin Esp 2009; 209:148-9. [DOI: 10.1016/s0014-2565(09)70883-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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[Quinine-induced renal bilateral cortical necrosis]. Nephrol Ther 2008; 4:181-6. [PMID: 18343736 DOI: 10.1016/j.nephro.2008.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Revised: 11/02/2007] [Accepted: 01/24/2008] [Indexed: 11/27/2022]
Abstract
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.
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Palapattu GS, Barbaric Z, Rajfer J. Acute bilateral renal cortical necrosis as a cause of postoperative renal failure. Urology 2001; 58:281. [PMID: 11489723 DOI: 10.1016/s0090-4295(01)01146-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- G S Palapattu
- Department of Urology, University of California, Los Angeles, School of Medicine, Los Angeles, California 90095, USA
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François M, Tostivint I, Mercadal L, Bellin MF, Izzedine H, Deray G. MR imaging features of acute bilateral renal cortical necrosis. Am J Kidney Dis 2000; 35:745-8. [PMID: 10739798 DOI: 10.1016/s0272-6386(00)70024-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
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.
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Affiliation(s)
- M François
- Departments of Nephrology and Radiology, Pitié-Salpêtrière University Hospital, Paris, France
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