Renal cortical necrosis

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

Contrast-enhanced CT demonstrates a non-enhancing renal cortex and a normal enhancing renal medulla (reverse rim sign). 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).

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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Article information

rID: 12714
System: Urogenital
Tag: kidney
Synonyms or Alternate Spellings:
  • Cortical necrosis of the kidney
  • Diffuse cortical necrosis
  • Acute cortical necrosis

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Cases and figures

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