Renal cortical necrosis at autopsy: a 12 year experience at a tertiary care centre in Mumbai

Abstract

Introduction: Renal cortical necrosis (RCN) is an unusual cause of acute renal failure but still causes significant mortality in developing countries. Objective: To review autopsies of histologically proven RCN reported in complete autopsies over the last 12 years. Methods: All autopsies performed from 2004-2016 with RCN were analyzed retrospectively. Results: A total of 13,896 autopsies were done at this centre over this twelve year period from 2004-2016. Of these, 26 cases were diagnosed as RCN, with an incidence of 0.19%. 978 of our total number of autopsies presented with Acute Kidney Injury (AKI) and the incidence of RCN in AKI was 2.7%. There were 844 maternal mortality deaths during this period of which 134 (15.9%) had AKI. RCN accounted for 2% of all maternal mortality deaths during this period. Obstetric cases amounted to 65.4% and non-obstetric cases to 34.6%. Pregnancy induced hypertension; intrauterine foetal death and postpartum hemorrhage were the leading causes of RCN amongst obstetric causes while septicemia, hemolytic uremic syndrome and poisoning were the leading non-obstetric causes. Microscopically, diffuse cortical necrosis was seen in 53.8% autopsies and patchy cortical necrosis was seen in 46.2% autopsies. Histopathology also showed intra-alveolar hemorrhage, bronchopneumonia, cerebral edema and acute respiratory distress syndrome. Conclusion: Our incidence of RCN was 0.19% at general autopsy, 2.7 % in autopsies with AKI and 2% of maternal mortality deaths at a tertiary care centre.RCN in AKI being 2.7% is significantly less than the 6-7% reported in developing countries. Diffuse pattern of cortical necrosis was more common than patchy cortical necrosis.

Renal cortical necrosis – a rare manifestation of dengue fever: A case report

“…The gold standard for diagnosing RCN is a renal biopsy, which will demonstrate ischemic necrosis of all renal cortex components (glomeruli, blood vessels, and tubules). [ 15 , 20 ] However, contrast enhanced CT scan and Magnetic resonance imaging (MRI) can be used as alternative modalities to reliably diagnose RCN. [ 21 , 22 ] Characteristic CT scan findings include the absence of the renal cortex enhancement, along with enhancement of the renal medulla and the absence of renal excretion.…”