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Kidney Week

Abstract: PO0115

Renal Cortical Necrosis: An Atypical Case from Presentation to Recovery

Session Information

Category: Trainee Case Report

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Abu Salman, Liann, Lankenau Medical Center, Wynnewood, Pennsylvania, United States
  • Hilburg, Rachel, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Geara, Abdallah Sassine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
Introduction

Renal cortical necrosis (RCN) is a rare cause of acute kidney injury (AKI) accounting for 1-2% of cases. It is most often associated with obstetric emergencies in developing countries. The most common non-obstetric etiology is hemolytic uremic syndrome, but it has also been described in renal allograft rejection, sepsis, and in rare cases pancreatitis where ten cases have been reported. We describe a case of severe renal cortical necrosis in a previously healthy young man with acute pancreatitis.

Case Description

A 29-year-old man with no significant medical history presented with severe epigastric pain and anuria for three days. He was diagnosed with alcohol-induced pancreatitis with a lipase level of 35,534U/L and AKI with a creatinine of 5.8mg/dL (baseline 1.2mg/dL). The anuria did not improve with fluid resuscitation, the AKI progressed and he was initiated on hemodialysis. Evaluation of AKI with hepatitis B and C serologies, HIV, complement levels and ANA was unremarkable. Kidney ultrasound showed increased echogenicity without hydronephrosis. An abdominal CT scan with IV contrast done for worsening fever and leukocytosis showed diffuse areas of non-enhancement involving bilateral renal cortices consistent with acute renal cortical necrosis. To note, throughout his presentation and admission, the patient was not hypotensive. He remained dialysis dependent for three months with oliguria that eventually improved and dialysis was discontinued with a stable eGFR of 20ml/min/1.73m2. He has remained off dialysis for the past five months and is undergoing transplant evaluation.

Discussion

RCN is thought to be an irreversible cause of AKI secondary to decreased perfusion, vasospasm and endothelial injury resulting in ischemia. It is frequently associated with hypotension but in our case the patient was normotensive. The mechanism leading to RCN associated with pancreatitis remains poorly understood. Acute pancreatitis, on the other hand, has been associated with other vasoocclusive ischemic complications (e.g. Purtscher's retinopathy). RCN is a devastating complication that often leads to dialysis dependence. Despite our patient showing signs of recovery, his prognosis remains poor. Further study is needed to understand its pathophysiology and potentially mitigate its consequences.