Renal cortical necrosis (RCN) is patchy or diffuse ischemic destruction of the renal cortex caused by significantly reduced renal arterial perfusion. It is a rare cause of acute kidney injury (AKI) and is associated with high mortality. Here, we review the case of RCN in a 15-year-old boy who developed AKI. A 15-year-old boy was referred to our hospital from a local hospital due to a sharp decrease in his renal function. He presented with acute flank pain, nausea with vomiting, and oliguria for the past two days. He had taken a single dose of antihistamine for nasal congestion. At our hospital, his peak blood pressure was 148/83 mmHg and he had a high body mass index of 32.9 kg/m². The laboratory data showed a blood urea nitrogen (BUN) of 28.4 mg/dL, a creatinine of 4.26 mg/dL, and a glomerular filtration rate estimated from the serum cystatin C of 20.2 mL/min/1.73m². Proteinuria (spot urine protein to creatinine ratio 1.66) with pyuria was observed. Kidney sonography showed parenchymal swelling and increased renal echogenicity. Due to rapidly progressing nephritis, steroid pulse therapy (750 mg/IV) was done on the second day of his admission and the patient showed complete recovery with normal renal function. However, the kidney biopsy findings revealed renal cortical hemorrhagic necrosis. Multifocal, relatively well-circumscribed, hemorrhagic necrotic areas (about 25%) were detected in the tubulointerstitium. Although RCN is an unusual cause of AKI, especially in children, pediatricians should consider the possibility of RCN when evaluating patients with rapidly decreasing renal function.
Acute Kidney Injury ; Adolescent ; Biopsy ; Blood Pressure ; Blood Urea Nitrogen ; Body Mass Index ; Child ; Creatinine ; Cystatin C ; Estrogens, Conjugated (USP) ; Flank Pain ; Glomerular Filtration Rate ; Humans ; Kidney ; Kidney Cortex Necrosis ; Male ; Mortality ; Nausea ; Necrosis ; Nephritis ; Obesity ; Oliguria ; Perfusion ; Proteinuria ; Pyuria ; Vomiting

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.
Acute Kidney Injury ; Adenoma ; Aged, 80 and over ; Creatinine ; Dialysis ; Dyspnea ; Female ; Hemorrhage* ; Humans ; Kidney Cortex Necrosis* ; Oliguria ; Pregnancy ; Pulmonary Edema ; Renal Dialysis ; Tranexamic Acid

Kidney cortex necrosis is a relatively rare cause of acute kidney injury and is characterized by complete or partial destruction of the renal cortex, but sparing of the medulla. Tranexamic acid has antifibrinolytic activity and is used to reduce bleeding. We report a rare case of kidney cortex necrosis caused by tranexamic acid. A 49-year-old woman complained of coughing up blood-tinged sputum. She had a history of bronchiectasis and was treated with tranexamic acid for 3 days. Four days after admission, she developed anuria and azotemia. Computerized tomography showed enhancement of the renal medulla, but not the bilateral renal cortex. The patient was treated with hemodialysis, and has since been maintained on hemodialysis for 6 months. Due to the development of kidney cortex necrosis in patients treated with tranexamic acid, all its potential complications should be considered.
Acute Kidney Injury ; Anuria ; Azotemia ; Bronchiectasis ; Cough ; Female ; Hemorrhage ; Humans ; Kidney ; Kidney Cortex ; Kidney Cortex Necrosis ; Middle Aged ; Renal Dialysis ; Sputum ; Tranexamic Acid

Kidney cortex necrosis is a relatively rare cause of acute kidney injury and is characterized by complete or partial destruction of the renal cortex, but sparing of the medulla. Tranexamic acid has antifibrinolytic activity and is used to reduce bleeding. We report a rare case of kidney cortex necrosis caused by tranexamic acid. A 49-year-old woman complained of coughing up blood-tinged sputum. She had a history of bronchiectasis and was treated with tranexamic acid for 3 days. Four days after admission, she developed anuria and azotemia. Computerized tomography showed enhancement of the renal medulla, but not the bilateral renal cortex. The patient was treated with hemodialysis, and has since been maintained on hemodialysis for 6 months. Due to the development of kidney cortex necrosis in patients treated with tranexamic acid, all its potential complications should be considered.
Acute Kidney Injury ; Anuria ; Azotemia ; Bronchiectasis ; Cough ; Female ; Hemorrhage ; Humans ; Kidney ; Kidney Cortex ; Kidney Cortex Necrosis ; Middle Aged ; Renal Dialysis ; Sputum ; Tranexamic Acid

Acute renal cortical necrosis is an anuric form of acute renal failure. We experienced a case of renal cortical necrosis complicated by tranexamic acid administration. To our knowledge, only three cases of renal cortical necrosis have been reported worldwide. A 49-year-old man was referred with hemothorax and multiple bone fractures following a traffic accident. Tranexamic acid, and hemocoagulase were injected three times a day. After the 4th dose of hemostatics, anuria developed abruptly, the platelet count decreased to 84,000 /microL, and the serum creatinine was increased to 2.56 from 1.06 mg/dL. On the 4th Intensive Care Unit (ICU) day, computed tomography (CT) showed bilateral renal cortical necrosis with normal renal arteries and aorta. The oliguria persisted for 14 days and temporary hemodialysis was performed. The serum creatinine had decreased to 2.12 mg/dL 8 months after discharge.
Accidents, Traffic ; Acute Kidney Injury ; Anuria ; Aorta ; Batroxobin ; Creatinine ; Fractures, Bone ; Hemostatics ; Hemothorax ; Humans ; Intensive Care Units ; Kidney Cortex Necrosis ; Middle Aged ; Oliguria ; Platelet Count ; Renal Artery ; Renal Dialysis ; Tranexamic Acid

Henoch-Schonlein purpura (HSP) is a vasculitis of the small vessels of the skin, joints, gastrointestinal tract, and kidneys characterized by immunoglobulin A deposits in the involved organs. HSP is typified by the classic tetrad of purpura, arthralgia, abdominal pain, and renal involvement. It is common in childhood, but may also occur in adults and can be accompanied by severe complications. Gastrointestinal symptoms occur in up to 85% of patients, and gastrointestinal involvement can manifest as severe problems including intussusception, obstruction, and perforation. The disease course is often self-limited, but severe manifestations occasionally require surgical intervention. We report the case of a 24-year-old man with HSP who presented with abdominal pain and vomiting. Computerized tomography revealed thickening of the ileal wall and multifocal disrupted prominent mucosal enhancement. These findings suggested hemorrhagic enteritis and mucosal necrosis. After treatment with high dose corticosteroids, the lesion improved and surgical intervention was avoided. Our experience suggests that corticosteroid therapy may help in controlling HSP with suspicious small bowel necrosis.
Abdominal Pain ; Adrenal Cortex Hormones ; Adult ; Arthralgia ; Enteritis ; Gastrointestinal Tract ; Humans ; Immunoglobulin A ; Intussusception ; Joints ; Kidney ; Necrosis ; Purpura ; Purpura, Schoenlein-Henoch ; Skin ; Steroids ; Vasculitis ; Vasculitis, Leukocytoclastic, Cutaneous ; Vomiting ; Young Adult

Acute bilateral renal cortical necrosis (BRCN) is a rare cause of renal failure. It has been reported that contrast-enhanced computed tomography provides characteristic findings of BRCN which correlates well with the histopathology making it an important non-invasive diagnostic modality during early phase of BRCN, improving survival rate and prognosis with early diagnosis and treatment. This report presents a case of 73-year old woman with BRCN due to hemolytic uremic syndrome. The patient recovered from anuria and showed complete recovery to normal renal function of her age and serum creatinine level after early initiation of hemodialysis. Furthermore, a normal radiologic finding of kidney was obtained after 52 days from onset of the disease by contrast-enhanced computed tomography. At present, she is preserved within the normal range renal function without renal replacement therapy.
Anuria ; Creatinine ; Early Diagnosis ; Female ; Hemolytic-Uremic Syndrome ; Humans ; Kidney ; Kidney Cortex Necrosis ; Prognosis ; Reference Values ; Renal Dialysis ; Renal Insufficiency ; Survival Rate

The objective of this research is to investigate the influence of rhBMP-2 on the renal tissue of rat with renal ischemia reperfusion injury. In this program the ischemia reperfusion rat model was established and Wistar rats were divided into six groups: sham operation group (S group), renal ischemia reperfusion injury group (R group), rhBMP-2 treatment group (B1, B2, B3 and B4 group). In the rhBMP treatment groups, rhBMP-2 was intravenously administered with different doses before reperfusion. The contents of TNF-alpha, IL-6, IL-8, MDA and SOD in kidney tissue were observed. At the same time, renal function (blood creatine (Scr) and urea nitrogen (BUN)) were measured. As a result, compared with renal ischemia reperfusion group, administration of rhBMP-2 significantly reduced the content of IL-6 and IL-8 (P < 0.05) and ameliorated renal dysfunction cellular damages (P < 0.05). Higher dose of rhBMP-2 may reduce the content of TNF-alpha (P < 0.05) in kidney tissue. rhBMP-2 also increased activity of SOD and reduced the level of MDA, BUN and Scr. So, we can draw a conclusion that rhBMP-2 treatment attenuates renal ischemia reperfusion injury through inhibition of pro-inflammatory cytokines production and anti-oxidation activity.
Adrenal Cortex ; pathology ; ultrastructure ; Animals ; Blood Urea Nitrogen ; Bone Morphogenetic Protein 2 ; pharmacology ; Creatine ; blood ; Interleukin-6 ; metabolism ; Interleukin-8 ; metabolism ; Kidney ; blood supply ; metabolism ; Male ; Malondialdehyde ; metabolism ; Random Allocation ; Rats ; Rats, Wistar ; Recombinant Proteins ; pharmacology ; Reperfusion Injury ; metabolism ; pathology ; Superoxide Dismutase ; metabolism ; Transforming Growth Factor beta ; pharmacology ; Tumor Necrosis Factor-alpha ; metabolism

PURPOSE: Acute tubular necrosis (ATN) is a serious complication in critically ill patients. This study investigated the renal outcome of severe ATN requiring RRT and prognostic factors for renal recovery. METHODS: Between January 2000 and May 2008, surviving patients with presumed ATN requiring dialysis were analyzed retrospectively. Patients with pre-existing chronic kidney disease and other causes of ARF rather than ATN were excluded. Primary outcomes were complete renal recovery (CR) and dialysis withdrawal. CR was defined as a return to basal serum creatinine level or creatinine <1.5 mg/dL (male) or <1.3 mg/dL (female) without dialysis. RESULTS: Of one hundred twenty two patients, 79 (65%) patients were male. The mean age was 54+/-16 years and 87 patients (71%) received continuous renal replacement therapy. 55% had ischemic ATN, 29% had septic ATN, and 16% had nephrotoxic ATN. Mean duration of dialysis was 12 (6-29) days. Dialysis withdrawal rate at 30 days and at 60 days after initiation of dialysis were 51% and 77 %, respectively. CR at 60 days after initiation was 50%. Multivariate analysis revealed that older age (per year, Hazard ratio (HR)=0.981, 95% Confidence interval (CI) 0.963 to 0.999), ischemic ATN (vs. toxic ATN, HR=0.481, 95% CI 0.238 to 0.974),and longer duration of oliguria (per day, HR=0.979, 95 % CI 0.962 to 0.996) were independent prognostic factors of renal recovery. CONCLUSION: Young age and short duration of oliguria were favorable factors for renal recovery from ATN requiring dialysis. The cause of ATN might be also an independent prognostic factor.
Acute Kidney Injury ; Creatinine ; Critical Illness ; Dialysis ; Humans ; Kidney Cortex Necrosis ; Male ; Multivariate Analysis ; Necrosis ; Oliguria ; Renal Insufficiency, Chronic ; Renal Replacement Therapy ; Retrospective Studies

Renal cortical necrosis (RCN) is a rare cause of acute renal failure in which there is a complete or partial destruction of the renal cortex with sparing of the medulla. We report here a case of acute bilateral RCN associated with intra-abdominal operation. A 70-year-old female patient was admitted to our hospital because of abdominal pain secondary to perforated diverticulits in sigmoid colon. A segmental resection of the sigmoid colon and end-to-end anastomosis was performed on the third hospital day. Two days later, she suddenly developed oligo-anuria and she was treated with hemodialysis. A contrast-enhanced abdominal computed tomography scan showed lack of enhancement of the renal cortex with enhancement of the renal medulla. On the 21th hospital day, renal biopsy was done and microscopic examination of the specimen revealed RCN. Since then, she has been on regular hemodialysis for over six months with no signs of renal recovery. Occult sepsis associated with peritonitis and intra-abdominal operation seems to be the most possible etiologic factor of RCN in our patient.
Abdominal Pain ; Acute Kidney Injury ; Aged ; Biopsy ; Colon, Sigmoid ; Female ; Humans ; Kidney Cortex Necrosis ; Peritonitis ; Renal Dialysis ; Renal Insufficiency ; Sepsis