Fact-sheet: Acute cortical necrosis
Updated on 04/21/2016 at 11:49 PM
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Definition
Irreversible necrosis of the renal cortex occurring in a context of severe and prolonged hemodynamic compromise.
Clinical features
Severe oliguria (risk factors: - Intravascular hemolysis and/or DIC in a septic or hypovolemic context. - Massive glomerulopathy - Major renal ischemia (arterial thrombosis, microcirculatory disturbance) - Prolonged renal hypoperfusion (cardiac surgery...) - Severe hydrosodium depletion with hypovolemia - Any hemorrhagic, hypovolemic, septic, or cardiogenic shock...
Laboratory findings
Acute kidney injury with increased serum creatinine and decreased renal clearance.
Ultrasound
B-mode: No definite abnormality. Color Doppler: Allows exclusion of renal vein or artery thrombosis. Persistence of intraparenchymal flow. Pulsed Doppler: May demonstrate resistive intraparenchymal flow. Contrast-enhanced ultrasound: Bilateral and symmetric involvement. Enhancement defect of the cortical territories, with sharp margins. Sparing of the cortex corticis (enhanced peripheral rim) and of the juxtamedullary cortex. The remainder of the parenchyma enhances normally.
CT
Not indicated due to renal failure.
May show a bilateral and symmetric enhancement defect of the renal cortex.
Management
Generally irreversible involvement.
Dialysis.
Differential diagnosis
Contrast-enhanced ultrasound is relatively characteristic.
Other diagnoses to consider and rule out are:
Renal vein thrombosis,
Renal artery thrombosis with partial and/or complete infarction,
Mixed cortical and medullary necrosis.