Acute cortical necrosis

Acute kidney injury caused by ischemic necrosis of the renal cortex. Renal cortex is very sensitive to hypoxia.

Kidney – acute cortical necrosis

Causes

Acute cortical necrosis can be caused many factors including vascular disease, infections, autoimmune problems, trauma, alcohol, pregnancy, to name a few and include the following:

• Acute tubular necrosis
• Autoimmune kidney disease
• Blood clot from cholesterol
• Decreased blood flow due to very low blood pressure due to burns, dehydration, hemorrhage, injury, septic shock, serious illness, or surgery
• Disorders that cause clotting within the kidney blood vessels
• Infections that directly injure the kidney, such as acute pyelonephritis or septicemia
• Pregnancy complications, including placenta abruption or placenta previa
• Urinary tract blockage
• Illicit drugs such as cocaine and heroine
• Medicines including non-steroidal anti-inflammatory drugs (NSAIDs), certain antibiotics and blood pressure medicines, intravenous contrast (dye), some cancer and HIV drugs

Renal cortical infarction showing coagulative necrosis

Symptoms

• Bloody stools
• Breath odor and metallic taste in the mouth
• Bruising easily
• Changes in mental status or mood
• Decreased appetite
• Fatigue or slow sluggish movements
• Flank pain (between the ribs and hips)
• High blood pressure  
• Nausea or vomiting, may last for days
• Swelling due to the body keeping in fluid
• Urination changes, such as little or no urine

Kidney ultrasound

Investigations

• BUN
• Creatinine clearance
• Serum creatinine
• Serum potassium
• Urinalysis
• USG of the kidneys
• CT or MRI of the kidneys

Treatment

Treatment depends on the cause and rapid reversal of the cause can lead to full recovery.

Alternative Names

• Diffuse bilateral renal cortical necrosis (BRCN)
• Diffuse cortical necrosis
• Acute cortical necrosis
• Acute kidney failure with acute cortical necrosis