DOI QR코드

DOI QR Code

A Case of Renal Cortical Necrosis in a 15-year-old Boy with Acute Kidney Injury

  • Lee, Mi-ji (Department of Pediatrics, Korea University College of Medicine) ;
  • Yim, Hyung Eun (Department of Pediatrics, Korea University College of Medicine) ;
  • Yoo, Kee Hwan (Department of Pediatrics, Korea University College of Medicine)
  • Received : 2019.03.14
  • Accepted : 2019.04.17
  • Published : 2019.04.30

Abstract

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 $32.9kg/m^2$. 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 $20.2mL/min/1.73m^2$. 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.

Keywords

References

  1. Prakash J, Singh VP. Changing picture of renal cortical necrosis in acute kidney injury in developing country. World J Nephrol 2015;4:480-6. https://doi.org/10.5527/wjn.v4.i5.480
  2. Beji S, Hajji M, Rais L, Kheder R, Jebali H, Smaoui W, K, et al. Acute renal cortical necrosis in pregnancy: Clinical course and changing prognosis. Nephrol Ther 2017;13:550-2. https://doi.org/10.1016/j.nephro.2016.10.007
  3. Prakash J, Vohra R, Wani IA, Murthy AS, Srivastva PK, Tripathi K, et al. Decreasing incidence of renal cortical necrosis in patients with acute renal failure in developing countries: a single-centre experience of 22 years from Eastern India. Nephrol Dial Transplant 2007;22:1213-7. https://doi.org/10.1093/ndt/gfl761
  4. Bloom R, Swenson RS, Coplon NS. Acute renal cortical necrosis. Variable course and changing prognosis. Calif Med 1973;119:1-5.
  5. Campbell AC, Henderson JL. Symmetrical cortical necrosis of the kidneys in infancy and childhood Arch Dis Child 1949;24:269-85. https://doi.org/10.1136/adc.24.120.269
  6. Anandan AK, Balachandran P, Chowksey A, Sankaranarayanan G, Samuel U. Bilateral renal cortical necrosis following acute pancreatitis - A rare complication of a common disease. Saudi J Kidney Dis Transpl 2018;29:1211-5. https://doi.org/10.4103/1319-2442.243968
  7. Danziger J, Chen KP, Lee J, Feng M, Mark RG, Celi LA, Mukamal KJ. Obesity, acute kidney injury, and mortality in critical illness. Crit Care Med 2016;44:328-34.
  8. Druml W, Metnitz B, Schaden E, Bauer P, Metnitz PG. Impact of body mass on incidence and prognosis of acute kidney injury requiring renal replacement therapy. Intensive Care Med 2010;36:1221-8. https://doi.org/10.1007/s00134-010-1844-2
  9. Schiffl H, Lang SM. Obesity, acute kidney injury and outcome of critical illness. Int Urol Nephrol 2017;49:461-6. https://doi.org/10.1007/s11255-016-1451-4
  10. Fogo AB, Lusco MA, Najafian B, Alpers CE. AJKD Atlas of Renal Pathology: Cortical Necrosis. Am J Kidney Dis 2016;67:e27-8.
  11. Jha V, Sakhuja V. Postpartum renal cortical necrosis. Nephrol Dial Transplant 2005;20:1010. https://doi.org/10.1093/ndt/gfh588
  12. Gopalakrishnan N, Dhanapriya J, Muthukumar P, Sakthirajan R, Dineshkumar T, Thirumurugan S, et al. Acute kidney injury in pregnancy-a single center experience. Ren Fail 2015;37:1476-80. https://doi.org/10.3109/0886022X.2015.1074493
  13. Ulinski T, Sellier-Leclerc AL, Tudorache E, Bensman A, Aoun B. Acute tubulointerstitial nephritis. Pediatr Nephrol 2012; 27:1051-7. https://doi.org/10.1007/s00467-011-1915-9
  14. Fontana J, Vogt A, Hohenstein A, Vettermann U, Doroshenko E, Lammer E, et al. Impact of steroids on the inflammatory response after ischemic acute kidney injury in rats. Indian J Nephrol 2017;27: 365-71. https://doi.org/10.4103/ijn.IJN_40_17
  15. Rodriguez PM, Morales E, Sanchez A, Milla M, Martinez MA, Praga M. Cortical necrosis: An uncommon cause of acute renal failure with a very poor outcome Nefrologia 2017;37:339-41. https://doi.org/10.1016/j.nefro.2016.10.017
  16. Pahwa N, Bharani R, Kumar R. Post-partum acute kidney injury. Saudi J Kidney Dis Transpl 2014; 25:1244-7. https://doi.org/10.4103/1319-2442.144259

Cited by

  1. Obesity and chronic kidney disease: prevalence, mechanism, and management vol.64, pp.10, 2021, https://doi.org/10.3345/cep.2021.00108