Kidney is the most important organ of the body whose function is to filter the blood in the body. Renal Cortical Necrosis results in renal failure due to ischemic (lack of blood supply) necrosis of the kidney. In this article, we will discuss about different symptoms, causes, and treatment rendered for Renal Cortical Necrosis.

Renal Cortical Necrosis (RCN)

How Is Renal Cortical Necrosis (RCN) Defined?

  • Reduced Blood Flow- The disease is caused by significant reduction of renal arterial perfusion.
  • Bilateral- Renal Cortical Necrosis involves both kidneys.
  • Reduced Kidney Blood Supply- because of following reasons
    • Vascular Spasm- Narrowing of artery,
    • Injured Blood Vessels- Micro vascular (smaller blood vessels) insult or injury and
    • Blood Clots- Small blood clots within small blood vessels.
  • Kidney Damage (Necrosis)-
    • Entire kidney
    • Subscapular Kidney Damage- Involves entire thickness of the partial kidney.
  • Extensive Necrosis Involves-
    • Medulla
    • Juxtamedullary Cortex
    • Subcapsular Cortex

Types of Renal Cortical Necrosis (RCN)

Renal Cortical Necrosis is classified into five different forms based on the severity as follows-

  • Focal Pathologic Form:
    • Small area of necrosis
    • No blood clots (thrombosis)
    • Patchy necrosis of renal tubule
  • Minor Pathologic Form:
    • Large area of necrosis
    • Blood clots observed in blood vessels of glomerulus and renal vessels.
  • Patchy Pathologic Form:
    • Necrotic patches observed in two thirds of cortex.
  • Gross Pathologic Form:
    • Entire cortex gets involved
    • Widespread blood clots within the arteries.
  • Confluent Pathologic Form:
    • Significant glomerular and tubular necrosis
    • No coagulation or blood clots.

Causes of Renal Cortical Necrosis (RCN)

Adult Patient

  • Vasospasm: Narrowing of blood vessels-
    • Lack of blood supply for brief period causes Acute Tubular Necrosis and partial kidney damage
    • Lack of blood supply for prolonged period causes Renal Tubular Necrosis and spread of blood clots in renal blood vessels.
  • Abruptio Placentae- Separation of placenta from uterine wall,1
  • Infection-
    • Septic Shock2
    • Infected Abortion
    • HIV
    • Pancreatitis
    • Malaria3
    • Meningitis
    • Systemic Lupus Erythematosus (SLE)4
  • Snake Bite
  • Major Injury- Auto accident or work accident

Neonatal Patient-

  • Fetal- Maternal transfusion
  • Asphyxia
  • Anemia
  • Dehydration
  • Placental Bleeding

Risk Factors For Renal Cortical Necrosis

  1. Neonatal (newborn)
  2. Miscellaneous

A. Neonatal Risk Factors for Renal Cortical Necrosis (RCN)

  • Congenital Heart Disorders
  • Dehydration
  • Perinatal Asphyxia
  • Anemia
  • Sepsis

B. Miscellaneous Risk Factors for Renal Cortical Necrosis (RCN)

  • Trauma
  • Snake bites
  • Poison
  • Use of NSAIDs
  • In some cases Contrast Media
  • Antiphospholipid Syndrome

Symptoms Of Renal Cortical Necrosis (RCN)

  • Flank Pain
  • Hematuria
  • Proteinuria
  • Lower Urine Output
  • Water Retention-
    • Edema feet (swelling of feet)
    • Enlarged liver
    • Pleural effusion (fluid collection around lungs)

Diagnosis of Renal Cortical Necrosis (RCN)

  • Serum Electrolytes- High potassium level
  • CBC- Low hemoglobin and red blood cell count
  • Coagulation Panel- Blood clot disorder
  • Urinalysis- Blood and protein in urine
  • Ultrasound of the kidneys- Kidney size is smaller
  • CT scan of the kidneys
  • Kidney Biopsy- shows necrosis and blood clots.

Treatment for Renal Cortical Necrosis (RCN)

  • Reestablish hemodynamic stability
  • Treat cause of Renal Cortical Necrosis- Malaria, SLE, HIV and sepsis
  • Fluid control
  • Diet control
  • Treat symptoms like irregular heart beats caused by high potassium
  • Dialysis

References:

1. Kidney disease in pregnancy: (Women's Health Series).

Gyamlani G1, Geraci SA.

South Med J. 2013 Sep;106(9):519-25..

2. Sepsis-induced acute bilateral renal cortical necrosis.

Huang CC, Huang JK.

Nephrology (Carlton). 2011 Nov;16(8):787.

3. Renal cortical necrosis and acute kidney injury associated with Plasmodium vivax: a neglected human malaria parasite.

Kute VB1, Vanikar AV, Ghuge PP, Goswami JG, Patel MP, Patel HV, Gumber MR, Shah PR, Trivedi HL.

Parasitol Res. 2012 Nov;111(5):2213-6.

4. Bilateral acute renal cortical necrosis in SLE-associated antiphospholipid syndrome.

Kim JO1, Kim GH, Kang CM, Park JS.

Am J Kidney Dis. 2011 Jun;57(6):945-7.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: May 15, 2014

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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