Cortical Necrosis of the Kidneys
Renal (kidney) cortical necrosis is death of the tissue in the outer part of kidney (cortex) that results from blockage of the small arteries that supply blood to the cortex and that causes acute kidney injury.
Renal cortical necrosis can occur at any age. About 10% of the cases occur in infants and children.
In newborns, more than half of the cases occur after delivery complicated by premature detachment of the placenta. The next most common cause is a bacterial infection of the bloodstream (sepsis).
In children, renal cortical necrosis may occur after severe infection, severe dehydration, shock, or the hemolytic-uremic syndrome (see Thrombotic Thrombocytopenic Purpura and Hemolytic-Uremic Syndrome).
In women, about half of the cases occur after complications of pregnancy, such as premature detachment of or abnormal position of the placenta, bleeding from the uterus, infections immediately after childbirth, blockage of arteries by amniotic fluid, death of the fetus within the uterus, and preeclampsia.
Other causes in adults include severe infection, blood loss after injuries, rejection of a transplanted kidney, burns, inflammation of the pancreas (pancreatitis), snakebite, use of certain drugs, and poisoning caused by certain chemicals.
Doctors may have difficulty making a diagnosis of renal cortical necrosis because it may resemble other types of acute kidney injury. Doctors may suspect renal cortical necrosis based on symptoms and the results of routine blood and urine tests in people who have predisposing conditions. The diagnosis is often confirmed with an imaging test such as computed tomography (CT) angiography. Kidney biopsy can give doctors the most accurate diagnostic information, but a biopsy involves removing tissue and can cause complications and may be unnecessary if the diagnosis is evident. Thus, a biopsy is not done in most people.
Treatment is supportive care, which may involve giving intravenous fluids, blood transfusion, antibiotics, dialysis, or a combination. The disorder that caused cortical necrosis is treated when possible.