Contribution of Acute Renal Cortical Necrosis to Acute Kidney Injury: A 25-year experience from a tertiary care renal unit in Pakistan
Acute Kidney Injury and Acute Cortical Necrosis
DOI:
https://doi.org/10.53778/pjkd93314Keywords:
Acute Kidney Injury (AKI), Acute Cortical necrosis (ACN), Pregnancy related AKI (PR-AKI), Snake Envenomation, Pakistan.Abstract
Background: Acute cortical necrosis (ACN) is a rare contributing factor to acute kidney injury (AKI). The present study aims to report clinico-pathological profile and outcome of ACN in the setting of AKI.
Patients and Methods: This study was carried out at XXXXXXXXX. Subjects for the study comprised a cohort of 349 patients, (6.2% of total AKI) seen over a period of 25 years. AKI was defined according to KDIGO guidelines and diagnosis of ACN was based on radiological or histological findings.
Results: From January 1990 to December 2014, 5,623 adult patients presented with AKI. Among these, 349 (6.2%) were found to have ACN. The mean age of ACN cohort was 29.33 ± 7.85 years. The major contributing cause was obstetrical AKI 286 (82%). On presentation 342 (98 %) were oligo-anuric. Histological diagnosis was available in 89 (25.50 %) cases, in 47 (53%) the pattern was diffuse and in 42 (47%) it was patchy. In rest, diagnosis was based on radiological findings. Hemodialysis was done in 346 (99.4 %). Complete recovery was seen in 9 (2.6 %), partial recovery in 76 (22%), chronic kidney disease (CKD) developed in 57 (16 %), end stage renal failure (ESRF) in 202 (58 %) while 5 (1.4 %) died during acute phase of illness.
Conclusion: ACN is still encountered as a cause of AKI. Some patients may remain dialysis free even with diffuse pattern on histological examination and this population should be closely monitored to avoid nephrotoxic exposure.
References
Schreiner GE. Bilateral cortical necrosis. In: Hamburger J, Grunfeld JP, eds. Nephrology. Wiley, New York: 1979; 411–430.
Chugh KS. Snake Bite Induced Acute Renal Failure in India. Kid Int. 1989; 35:891-907.
Kute VB, Vanikar AV, Ghuge PP, et al. Renal cortical necrosis and acute kidney injury associated with Plasmodium vivax: a neglected human malaria parasite. Parasitol Res. 2012; 111(5):2213-6.
Naqvi R. Plasmodium Vivax causing acute kidney injury: A foe less addressed. Pak J Med Sci. 2015; 31(6):1472-5.
Huang CC, Huang JK. Sepsis-induced acute bilateral renal cortical necrosis. Nephrology. 2011; 16(8):787. doi.org/10.1111/j.1440-1797.2011.01478.x
Kim JO, Kim GH, Kang CM, et al. Bilateral acute renal cortical necrosis in SLE-associated antiphospholipid syndrome. Am JKidney Dis. 2011 Jun. 57(6):945-7.
Krishna GS, Kishore KC, Sriram NP, et al. Bilateral renal cortical necrosis in acute pancreatitis. Indian J Nephrol. 2009;19(3):125.
Mansoor K, Zawodniak A, Nadasdy T, et al. Bilateral renal cortical necrosis associated with smoking synthetic cannabinoids. World J Clin Cases. 2017 Jun 16. 5 (6):234-7.
Frimat M, Decambron M, Lebas C, et al. Renal Cortical Necrosis in Postpartum Hemorrhage: A Case Series. Am J Kidney Dis. 2016; 68 (1):50-7.doi: 10.1053/j.ajkd.2015.11.022.
Prakash J,Vohra R, Wani IA, et al. Decreasing incidence of renal cortical necrosis in patients with acute renal failure in developing countries: a single center experience of 22 years from Eastern India. Nephrol Dial Trans. 2007; 22:1213-7
Spiesecke P, Münch F, Fischer T, et al. Multiparametric ultrasound findings in acute kidney failure due to rare renal cortical necrosis. Scientific Reports.2021;11:2060. https://doi.org/10.1038/s41598-021-81690-x
Luo X,Cielo AG, Velez JCQ.Abnormal Imaging Findings of the Kidneys in a Patient with Shock. KIDNEY360 1: 1462–1463, 2020. doi: https://doi.org/10.34067/KID.0003692020
Kim HJ, Chao OK. CT Scan as an important diagnostic tool in the initial phase of diffuse bilateral renal cortical necrosis. Clinic Nephrol. 1996; 45(2):125-30.
KDIGO: Definition and classification of AKI. KI Suppl. 2012;2:19-36
Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kid Int. 2005; 67:2089-2100.
Grünfeld JP, Ganeval D, Bournérias F. Acute renal failure in pregnancy. Kidney Int 1980; 18: 179-91. DOI: 10.1038/ki.1980.127.
Pertuiset N, Grunfeld JP. Acute renal failure in pregnancy. Baillieres Clin Obstet Gynaecol. 1994; 8(2):333-51.
Ali A, Ali MA, Ali MU. Obstetrical associated renal cortical necrosis: though uncommon but not rare! J Ayub Med Coll. 2010;22(3):74-6.
Kazi JI, Mubarak M, Akhter F, et al. Spectrum of pathological lesions in acute renal failure. J Coll Physicians Surg Pak 2003;13(1):22–4.
Prakash J, Pant P, Singh AK, et al. Renal cortical necrosis is a disappearing entity in obstetric acute kidney injury in developing countries: our three decade of experience from India. Ren Fail. 2015 Aug. 37 (7):1185-9.
Sahay M, Swain M, Padua M. Renal cortical necrosis in tropics. Saudi J Kidney Dis Transpl. 2013 Jul. 24(4):725-30.
Sitprija V, Chaiyabutr N. Nephrotoxicity in snake envenomation. J Nat Toxins. 1999; 8(2):271-7
Naqvi R. Snake-bite-induced Acute Kidney Injury. J Coll Phys Surg Pak. 2016; 26 (6): 517-20.
Baliga KV, Narula AS, Khanduja R, et al. Acute Cortical Necrosis in Falciparum Malaria: An Unusual Manifestation, Renal Failure, 2008;30(4):461-3, DOI: 10.1080/08860220801964293.
Nair RK, Rao KA, Mukherjee D, et al. Acute kidney Injury due to Acute Cortical Necrosis Following Vivax Malaria. Saudi J Kid Dis Transpl. 2019;30(4):960-3.
Naqvi R, Akhtar F, Ahmed E, et al. Malarial Acute Kidney Injury: 25 Years Experience from a Center in an Endemic Region. British Journal of Medicine & Medical Research. 2016;12(6): 1-6, Article no. BJMMR.21471.
Shultz PJ, Raij L. Endogenously synthesized nitric oxide prevents endotoxin induced glomerular thrombosis. J Clinc Invest. 1992; 90(5):1718-25.
Moss SW, Gary NE, Eisinger RP. Renal cortical necrosis following streptococcal infection. Arch Intern Med, 1977; 137 (9):1196-7.
Kirk P. Conrad, S. Ananth Karumanchi, Chapter Cortical Necrosis in Seldin and Giebisch's The Kidney. Vol 2. (Fifth Edition), 2013. Pages 2689-2761. https://doi.org/10.1016/B978-0-12-381462-3.00081-1.
Kennedy C, Khilji S, Dorman A, et al. Bilateral Renal Cortical Necrosis in Meningococcal Meningitis. Case Reports in Nephrol. 2011; Article ID 274341, 3 pages. doi:10.1155/2011/274341
Naqvi R, Akhtar F, Farooq U, et al. From Diamonds to Black Stone; Myth to Reality: Acute Kidney Injury with Paraphenylene diamine Poisoning. Nephrology. 2015; 20:887-91.
Kleinknecht D, Gru ̈nfeld JP, Gomez PC, et al. Diagnostic procedures and long-term prognosis in bilateral renal cortical necrosis. Kidney Int. 1973; 4: 390–400. DOI 10.1038/ki.1973.135.
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