Cases reported "Kidney Cortex Necrosis"

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1/8. Unilateral acute renal cortical necrosis: correlative imaging.

    Bilateral acute cortical necrosis is a rare form of acute renal failure characterized by necrosis of the renal cortex and sparing of the medulla. Little information on the imaging presentation of bilateral acute renal cortical necrosis is available. The enhanced CT appearance is pathognomonic and diagnostic. The unilateral presentation of acute cortical necrosis is extremely rare, and no imaging methods have been described. The authors chose to apply scintigraphic evaluation to this unique condition complementary to CT to confirm the diagnosis. Mercaptoacetylglycine (T3) was selected to assess tubular damage, in contrast to the pure glomerular agent DTPA. Evidence of some tubular function and clear delineation of the shrunken kidney was found. Conversely, in the DTPA study the kidney was not visualized. A DMSA scan was performed for assessment of viability of the renal cortex and showed a photopenic halo around the small area of the viable cortex of the upper pole. The halo sign represents a cortical loss. The visualization of the upper pole as evidence of cortical viability as a consequence of collateral blood flow from capsular vessels was seen on angiography. Radiographic and scintigraphic correlation of this rare condition may be an effective means to confirm the diagnosis and to establish the extent of involvement. However, contrast CT remains the preferred method in the diagnosis of acute cortical necrosis.
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2/8. MR imaging of acute renal cortical necrosis. A case report.

    MR imaging of a patient with acute renal cortical necrosis secondary to massive bleeding following an abortion is presented. The kidneys were enlarged with a high signal intensity observed in the renal cortex on both T1- and T2-weighted images. Follow-up MR imaging showed thinned renal cortex of low signal intensity on both pulse sequences representing renal cortical calcification which was confirmed on conventional radiography and CT.
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3/8. Unilateral renal cortical necrosis with contralateral hydronephrosis after surgery for uterus carcinoma.

    Renal cortical necrosis (RCN) represents a rare cause of acute renal failure that is characterized by necrosis of the renal cortex with sparing of the medulla. Most previous RCN cases reported have been bilateral and have occurred in pregnancy. Unilateral RCN is a quite rare disorder. Here, we report a case of unilateral RCN with contralateral hydronephrosis after surgery for uterus carcinoma. In this patient it seems that hydronephrosis had been present before RCN occurrence. It is suggested that ureteric obstruction protects against RCN development.
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4/8. CT findings in acute renal cortical necrosis.

    Acute renal cortical necrosis has three characteristic findings on contrast enhanced CT: (a) lack of enhancement of the renal cortex, (b) enhancement of the renal medulla, and (c) absent renal excretion.
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5/8. Different functional characteristics of residual nephrons in infantile vs adult diffuse cortical necrosis.

    In this report we study the functional characteristics of residual nephrons in a 37 year-old woman, 7 months after diffuse bilateral cortical necrosis (CN) of unknown etiology, and in two infants, aged 13 and 15 months, who suffered CN in early infancy after surgical shock and acute dehydration, respectively. In the three cases CN was proven histologically by renal biopsy but undamaged nephrons were only present in the juxtamedullary area in the adult patient whereas in the two infants they were located in the outer part of the cortex. At the time of the study all patients presented a similar degree of renal insufficiency (creatinine clearance: 17-23 ml/min/1.37 m2). The adult patient showed a partly conserved ability to concentrate the urine, a marked free water formation in relation to the degree of distal sodium delivery and an unimpaired capacity to acidify the urine after an acid load. Both infants, by the contrary, were unable to concentrate the urine, had lower free water formation at similar rates of distal sodium delivery and presented a clear incapacity to acidify the urine. These results confirm previous finding indicating the sparing of juxtamedullary nephrons after CN in the adult subject but favor the existence of a surviving population of superficial nephron when CN occurs in early infancy. These differences are probably in relation with associated damage of deep cortex and medulla infancy due to the specific characteristics of blood flow distribution present at that age.
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6/8. Case report: the diagnostic value of contrast-enhanced computed tomography in acute bilateral renal cortical necrosis.

    Acute bilateral renal cortical necrosis is a relatively rare cause of acute renal failure accounting for only 2% of cases in the western world. The pathophysiology of this condition is complex, but ultimately leads to the destruction of the renal cortex with sparing of the renal medulla. A definitive diagnosis is based on renal histology. In this report we describe a patient in whom this diagnosis was made using contrast-enhanced computed tomography as renal biopsy was contraindicated.
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7/8. Contrast-enhanced computed tomography for demonstration of bilateral renal cortical necrosis.

    Bilateral renal cortical necrosis as a rare form of acute renal failure was encountered in two patients with sepsis and acute renal failure. In both cases contrast-enhanced computed tomography showed characteristic findings: absent specification of the renal cortex and enhancement of subcapsular and juxtamedullary areas and of the medulla without excretion of contrast medium. Establishing an early diagnosis and visualizing the extent of renal cortical necrosis by means of contrast-enhanced computed tomography allow a prognostic evaluation of renal function and further planning of therapy.
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8/8. CT scan as an important diagnostic tool in the initial phase of diffuse bilateral renal cortical necrosis.

    The serious clinical circumstances and coagulopathy generally accompanied by diffuse bilateral renal cortical necrosis (BRCN), especially during the early period, do not allow renal biopsy being well known as a gold standard diagnostic method for BRCN. Therefore, other noninvasive diagnostic modalities in the initial phase of BRCN have been tried, and, among them, contrast-enhanced computerized tomography (CT) was found to provide very characteristic representative findings, i.e., low attenuation of cortex sparing thin rim of subcapsular cortex and medulla, correlating well with histological findings of renal biopsy performed in the late somewhat stable clinical status or at autopsy. These specific CT findings were reported consistently with or without renal biopsy in several articles recently. Herein, we present a 38-year-old woman of massive automobile accident victim, developed protracted total anuria as well as shock with disseminated intrasvascular coagulation (DIC), and diagnosed as BRCN by the specific CT findings without renal biopsy in the second day of admission. Simultaneously, all the scattered cases of BRCN diagnosed by CT are reviewed and contrast to the findings of other diagnostic procedures performed for the same cases. The importance of contrast-enhanced CT as noninvasive diagnostic procedure during the initial phase of BRCN is stressed.
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