Renal cortical necrosis. A literature review and new diagnostic tools

Abstract

Acute renal cortical necrosis (ARCN) is the rare cause of acute kidney injury (AKI) in the world population, it is more common among women in the 2nd and 3rd trimester of gravity. Amid obstetrical causes placental abruption is the most frequent, whereas hemolytic uremic syndrome and sepsis are one of the non-obstetrical causes. Its basic pathomorphological feature is the ischemic necrosis of all cortex elements (vessels, glomeruli and tubules). The characteristic triad of symptoms: anuria, hematuria and flank pain distinguishes RCN among other forms of AKI during pregnancy, although anuria is what arouses suspicion. Ultrasonography, computed tomography and renal biopsy are used in diagnostics. A very interesting new diagnostic tool is contrast-enhanced ultrasound. The first thing to do is to treat the disease which caused RCN, align hemodynamic disorders and perform dialysis. Unfortunately prognosis in the disease is bad, kidney dysfunction is usually irreversible and mortality very high.