Usually the cause is a major, catastrophic disorder that decreases blood pressure.
Symptoms may include dark urine, decreased urine volume, fever, and pain in the side of the body.
Sometimes an imaging test or tissue analysis (biopsy) is done to confirm the diagnosis.
(See also Overview of Blood Vessel Disorders of the Kidneys Overview of Blood Vessel Disorders of the Kidneys The blood flow to the kidneys needs to be intact for the kidneys to function properly. Any interruption of or reduction in the blood flow can cause kidney damage or dysfunction and, if long-standing... read more .)
Renal cortical necrosis can occur at any age. About 10% of the cases occur in infants and children.
Causes of Cortical Necrosis of the Kidneys
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 Sepsis and Septic Shock Sepsis is a serious bodywide response to bacteremia or another infection plus malfunction or failure of an essential system in the body. Septic shock is life-threatening low blood pressure ... read more ).
In children, renal cortical necrosis may occur after severe infection, severe dehydration Dehydration Dehydration is a deficiency of water in the body. Vomiting, diarrhea, excessive sweating, burns, kidney failure, and use of diuretics may cause dehydration. People feel thirsty, and as dehydration... read more , shock Shock Shock is a life-threatening condition in which blood flow to the organs is low, decreasing delivery of oxygen and thus causing organ damage and sometimes death. Blood pressure is usually low... read more , or the hemolytic-uremic syndrome Hemolytic-Uremic Syndrome (HUS) Hemolytic-uremic syndrome (HUS) is a serious disorder that usually occurs in children and involves the formation of small blood clots throughout the body that block the flow of blood to vital... read more .
In women, about half of the cases occur after complications of pregnancy, such as premature detachment of the placenta Placental Abruption Placental abruption is the premature detachment of a normally positioned placenta from the wall of the uterus, usually after 20 weeks of pregnancy. Women may have vaginal bleeding and/or severe... read more or abnormal position of the placenta Placental Abruption Placental abruption is the premature detachment of a normally positioned placenta from the wall of the uterus, usually after 20 weeks of pregnancy. Women may have vaginal bleeding and/or severe... read more , 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 Overview of Pancreatitis Pancreatitis is inflammation of the pancreas. The pancreas is a leaf-shaped organ about 5 inches (about 13 centimeters) long. It is surrounded by the lower edge of the stomach and the first... read more ), snakebite Snakebites Venomous snakes in the United States include pit vipers (rattlesnakes, copperheads, and cottonmouths) and coral snakes. Severe envenomation can cause damage to the bitten extremity, bleeding... read more 
, use of certain drugs, and poisoning caused by certain chemicals Overview of Poisoning Poisoning is the harmful effect that occurs when a toxic substance is swallowed, is inhaled, or comes in contact with the skin, eyes, or mucous membranes, such as those of the mouth or nose... read more .
Symptoms of Cortical Necrosis of the Kidneys
The urine often becomes red or dark brown because of the presence of blood. Pain along both sides of the lower back may occur. A fever is often present. Changes in blood pressure, including mildly high pressure or even low pressure, are common. Urine flow may slow or stop.
Diagnosis of Cortical Necrosis of the Kidneys
Routine blood and urine tests
Imaging test
Sometimes kidney biopsy
Doctors may have difficulty making a diagnosis of renal cortical necrosis because it may resemble other types of acute kidney injury Acute Kidney Injury Acute kidney injury is a rapid (days to weeks) decline in the kidneys’ ability to filter metabolic waste products from the blood. Causes include conditions that decrease blood flow to the kidneys... read more . 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 angiography CT angiography In computed tomography (CT), which used to be called computed axial tomography (CAT), an x-ray source and x-ray detector rotate around a person. In modern scanners, the x-ray detector usually... read more 
(CT angiography). Kidney biopsy Kidney biopsy Site-specific biopsies and cell sampling are also used in the evaluation of people with suspected kidney and urinary tract disorders. (See also Overview of the Urinary Tract.) A kidney biopsy... read more 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 of Cortical Necrosis of the Kidneys
Supportive care
Treatment of the underlying disorder
Treatment is supportive care, which may involve giving intravenous fluids, blood transfusion Overview of Blood Transfusion A blood transfusion is the transfer of blood or a blood component from one healthy person (a donor) to a sick person (a recipient). Transfusions are given to increase the blood's ability to... read more 
, antibiotics, dialysis Dialysis Dialysis is an artificial process for removing waste products and excess fluids from the body, a process that is needed when the kidneys are not functioning properly. There are a number of reasons... read more 
, or a combination. The disorder that caused cortical necrosis is treated when possible.
In recent years, with improved treatment, prognosis has improved. About 80% of people live a year or longer, although most people need permanent dialysis or kidney transplantation Kidney Transplantation Kidney transplantation is the removal of a healthy kidney from a living or recently deceased person and then its transfer into a person with end-stage kidney failure. (See also Overview of Transplantation... read more 
.
More Information
The following are some English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
American Association of Kidney Patients (AAKP): AAKP improves the lives of patients through education, advocacy, and promotion of a sense of community among patients with kidney disease.
American Kidney Fund (AKF): AKF provides information about kidney disease and kidney transplant, needs-based financial assistance to help manage medical expenses, webinars for medical professionals, and opportunities for advocacy.
National Kidney Foundation (NKF): This clearinghouse provides everything from information on the basics of kidney function to access to treatment and support for people with kidney disease, continuing medical education courses, and research opportunities and grant support for medical professionals.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): General information on kidney diseases, including research discoveries, statistics, and community health and outreach programs.
