Acute renal cortical necrosis--a study of 113 patients.
Over a 28-year period, 113 out of 2986 (3.8%) patients dialysed for acute renal failure at a referral center in North India were diagnosed to have acute renal cortical necrosis (ACN). Obstetric causes were responsible for ACN in 56.6% patients and nonobstetric causes in 43.4%. Within the obstetric group, ACN developed in association with complications of late pregnancy in 37.1% and following septic abortion in 19.5%. The various nonobstetric causes included viperine snake bite in 14.2%, hemolytic uremic syndrome in 11.5%, renal allograft rejection in 5.3%, acute gastroenteritis in 4.4%, acute pancreatitis in 3.5%, septicemia in 2.7%, and trauma and drug-induced IV hemolysis in 0.9% patients. Total anuria was the commonest presenting feature and was noted in 78.8% of patients. Renal histology showed diffuse cortical necrosis in 62.8% and patchy lesions in 37.2% patients. Computerized tomography (CT scan) of the kidneys revealed characteristic diagnostic findings in all the 5 patients in whom it was done. Dialytic support could be withdrawn as a result of improvement in renal function in 19 patients with patchy cortical necrosis. Dialysis-free survival of as long as 12 years has been recorded. The present study shows that, in contrast to the Western world, ACN continues to be a common cause of acute renal failure in developing countries. CT scan of the kidneys is helpful in establishing an early diagnosis.
Chugh
K S
KS
Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Jha
V
V
Sakhuja
V
V
Joshi
K
K
D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D003906:Developing Countries; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007668:Kidney / Q000000981:diagnostic imaging; D007673:Kidney Cortex Necrosis / Q000150:complications / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000209:etiology; D006435:Renal Dialysis; D014057:Tomography, X-Ray Computed