Contribution of Acute Renal Cortical Necrosis to Acute Kidney Injury: A 25-year experience from a tertiary care renal unit in Pakistan
Acute Kidney Injury and Acute Cortical Necrosis
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https://doi.org/10.53778/pjkd93314מילות מפתח:
Acute Kidney Injury (AKI), Acute Cortical necrosis (ACN), Pregnancy related AKI (PR-AKI), Snake Envenomation, Pakistan.תקציר
Background: Acute cortical necrosis (ACN) is a rare contributing factor to acute kidney injury (AKI). The present study aims to report clinico-pathological profile and outcome of ACN in the setting of AKI.
Patients and Methods: This study was carried out at XXXXXXXXX. Subjects for the study comprised a cohort of 349 patients, (6.2% of total AKI) seen over a period of 25 years. AKI was defined according to KDIGO guidelines and diagnosis of ACN was based on radiological or histological findings.
Results: From January 1990 to December 2014, 5,623 adult patients presented with AKI. Among these, 349 (6.2%) were found to have ACN. The mean age of ACN cohort was 29.33 ± 7.85 years. The major contributing cause was obstetrical AKI 286 (82%). On presentation 342 (98 %) were oligo-anuric. Histological diagnosis was available in 89 (25.50 %) cases, in 47 (53%) the pattern was diffuse and in 42 (47%) it was patchy. In rest, diagnosis was based on radiological findings. Hemodialysis was done in 346 (99.4 %). Complete recovery was seen in 9 (2.6 %), partial recovery in 76 (22%), chronic kidney disease (CKD) developed in 57 (16 %), end stage renal failure (ESRF) in 202 (58 %) while 5 (1.4 %) died during acute phase of illness.
Conclusion: ACN is still encountered as a cause of AKI. Some patients may remain dialysis free even with diffuse pattern on histological examination and this population should be closely monitored to avoid nephrotoxic exposure.
##submission.citations##
Schreiner GE. Bilateral cortical necrosis. In: Hamburger J, Grunfeld JP, eds. Nephrology. Wiley, New York: 1979; 411–430.
Chugh KS. Snake Bite Induced Acute Renal Failure in India. Kid Int. 1989; 35:891-907.
Kute VB, Vanikar AV, Ghuge PP, et al. Renal cortical necrosis and acute kidney injury associated with Plasmodium vivax: a neglected human malaria parasite. Parasitol Res. 2012; 111(5):2213-6.
Naqvi R. Plasmodium Vivax causing acute kidney injury: A foe less addressed. Pak J Med Sci. 2015; 31(6):1472-5.
Huang CC, Huang JK. Sepsis-induced acute bilateral renal cortical necrosis. Nephrology. 2011; 16(8):787. doi.org/10.1111/j.1440-1797.2011.01478.x
Kim JO, Kim GH, Kang CM, et al. Bilateral acute renal cortical necrosis in SLE-associated antiphospholipid syndrome. Am JKidney Dis. 2011 Jun. 57(6):945-7.
Krishna GS, Kishore KC, Sriram NP, et al. Bilateral renal cortical necrosis in acute pancreatitis. Indian J Nephrol. 2009;19(3):125.
Mansoor K, Zawodniak A, Nadasdy T, et al. Bilateral renal cortical necrosis associated with smoking synthetic cannabinoids. World J Clin Cases. 2017 Jun 16. 5 (6):234-7.
Frimat M, Decambron M, Lebas C, et al. Renal Cortical Necrosis in Postpartum Hemorrhage: A Case Series. Am J Kidney Dis. 2016; 68 (1):50-7.doi: 10.1053/j.ajkd.2015.11.022.
Prakash J,Vohra R, Wani IA, et al. Decreasing incidence of renal cortical necrosis in patients with acute renal failure in developing countries: a single center experience of 22 years from Eastern India. Nephrol Dial Trans. 2007; 22:1213-7
Spiesecke P, Münch F, Fischer T, et al. Multiparametric ultrasound findings in acute kidney failure due to rare renal cortical necrosis. Scientific Reports.2021;11:2060. https://doi.org/10.1038/s41598-021-81690-x
Luo X,Cielo AG, Velez JCQ.Abnormal Imaging Findings of the Kidneys in a Patient with Shock. KIDNEY360 1: 1462–1463, 2020. doi: https://doi.org/10.34067/KID.0003692020
Kim HJ, Chao OK. CT Scan as an important diagnostic tool in the initial phase of diffuse bilateral renal cortical necrosis. Clinic Nephrol. 1996; 45(2):125-30.
KDIGO: Definition and classification of AKI. KI Suppl. 2012;2:19-36
Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kid Int. 2005; 67:2089-2100.
Grünfeld JP, Ganeval D, Bournérias F. Acute renal failure in pregnancy. Kidney Int 1980; 18: 179-91. DOI: 10.1038/ki.1980.127.
Pertuiset N, Grunfeld JP. Acute renal failure in pregnancy. Baillieres Clin Obstet Gynaecol. 1994; 8(2):333-51.
Ali A, Ali MA, Ali MU. Obstetrical associated renal cortical necrosis: though uncommon but not rare! J Ayub Med Coll. 2010;22(3):74-6.
Kazi JI, Mubarak M, Akhter F, et al. Spectrum of pathological lesions in acute renal failure. J Coll Physicians Surg Pak 2003;13(1):22–4.
Prakash J, Pant P, Singh AK, et al. Renal cortical necrosis is a disappearing entity in obstetric acute kidney injury in developing countries: our three decade of experience from India. Ren Fail. 2015 Aug. 37 (7):1185-9.
Sahay M, Swain M, Padua M. Renal cortical necrosis in tropics. Saudi J Kidney Dis Transpl. 2013 Jul. 24(4):725-30.
Sitprija V, Chaiyabutr N. Nephrotoxicity in snake envenomation. J Nat Toxins. 1999; 8(2):271-7
Naqvi R. Snake-bite-induced Acute Kidney Injury. J Coll Phys Surg Pak. 2016; 26 (6): 517-20.
Baliga KV, Narula AS, Khanduja R, et al. Acute Cortical Necrosis in Falciparum Malaria: An Unusual Manifestation, Renal Failure, 2008;30(4):461-3, DOI: 10.1080/08860220801964293.
Nair RK, Rao KA, Mukherjee D, et al. Acute kidney Injury due to Acute Cortical Necrosis Following Vivax Malaria. Saudi J Kid Dis Transpl. 2019;30(4):960-3.
Naqvi R, Akhtar F, Ahmed E, et al. Malarial Acute Kidney Injury: 25 Years Experience from a Center in an Endemic Region. British Journal of Medicine & Medical Research. 2016;12(6): 1-6, Article no. BJMMR.21471.
Shultz PJ, Raij L. Endogenously synthesized nitric oxide prevents endotoxin induced glomerular thrombosis. J Clinc Invest. 1992; 90(5):1718-25.
Moss SW, Gary NE, Eisinger RP. Renal cortical necrosis following streptococcal infection. Arch Intern Med, 1977; 137 (9):1196-7.
Kirk P. Conrad, S. Ananth Karumanchi, Chapter Cortical Necrosis in Seldin and Giebisch's The Kidney. Vol 2. (Fifth Edition), 2013. Pages 2689-2761. https://doi.org/10.1016/B978-0-12-381462-3.00081-1.
Kennedy C, Khilji S, Dorman A, et al. Bilateral Renal Cortical Necrosis in Meningococcal Meningitis. Case Reports in Nephrol. 2011; Article ID 274341, 3 pages. doi:10.1155/2011/274341
Naqvi R, Akhtar F, Farooq U, et al. From Diamonds to Black Stone; Myth to Reality: Acute Kidney Injury with Paraphenylene diamine Poisoning. Nephrology. 2015; 20:887-91.
Kleinknecht D, Gru ̈nfeld JP, Gomez PC, et al. Diagnostic procedures and long-term prognosis in bilateral renal cortical necrosis. Kidney Int. 1973; 4: 390–400. DOI 10.1038/ki.1973.135.
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