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Renal cortical necrosis

Dr Yuranga Weerakkody and Radswiki et al.

Renal cortical necrosis occurs as a result of severe systemic illness in a variety of settings and can result in permanent renal impairment. 

Epidemiology

The epidemiology of renal cortical necrosis reflects that of the underlying cause:

  • severe haemodynamic shock
    • traumatic blood loss
    • postpartum haemorrhage
    • septic shock
    • venom toxin
    • transfusion reaction
  • severe dehydration
  • haemolytic uremic syndrome (HUS)
  • renal transplantation

Radiographic features

CT

Contrast-enhanced CT demonstrates a non-enhancing renal cortex. A very thin rim of contrast enhancement (cortical rim sign) may persist and should not be mistaken for adequate perfusion. 

Eventually dystrophic calcification of the renal cortex may be seen (cortical nephrocalcinosis).

MRI

Low signal intensity on both T1 and T2 weighted sequences affecting the inner renal cortex and the columns of Bertin is the major characteristic finding of renal cortical necrosis 1.

Additional features include :

  • swelling of both kidneys
  • corticomedullary differentiation seen better on T2-weighted images instead of T1-weighted images

Note that the cortical rim sign can persist in renal cortical necrosis  because of its separate capsular blood supply.

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