Approach Considerations

The diagnostic characteristics of renal cortical necrosis can be detected via the following^[15]:

Serum electrolytes
Complete blood count (CBC)
Coagulation studies
Urinalysis
Radiography
Ultrasonography
Contrast-enhanced computed tomography (CT) scanning
Renal scanning
Kidney biopsy

Serum Electrolytes

Serum electrolyte measurements and renal function tests are used in patients with renal cortical necrosis (RCN) to check for hyperkalemia, hypocalcemia, metabolic acidosis, and elevated creatinine levels.

CBC

A CBC may reveal hemolytic anemia and thrombocytopenia.

Coagulation Studies

Coagulation studies detect low fibrinogen levels and increased fibrin-degradation products.

Urinalysis

Urinalysis detects hematuria, proteinuria, red blood cell (RBC) casts, and granular casts.

Radiography

Thin cortical shells or tram lines caused by calcification are a radiologic hallmark, but they develop only 4-5 weeks after the initial insult.

Ultrasonography

The ultrasonogram initially shows enlarged kidneys with reduced blood flow.^[16]Cortical tissue becomes shrunken later in disease progression.

Contrast-Enhanced CT Scanning

Computed tomography (CT) scanning with contrast is the most sensitive imaging modality in renal cortical necrosis.

Diagnostic features of renal cortical necrosis include absent opacification of the renal cortex and enhancement of subcapsular and juxtamedullary areas and of the medulla without excretion of contrast medium.^[17]

Initiating hemodialysis immediately after the procedure may be necessary to minimize contrast-mediated renal damage, although conclusive evidence for the efficacy of this practice is lacking.

Renal Scanning

Diethylenetriamine penta-acetic acid (DTPA) scanning reveals markedly diminished perfusion with delayed or no function.

Renal scan is the imaging technique of choice to diagnose renal cortical necrosis in transplant kidneys or if contrast-enhanced CT scanning is unavailable.

Kidney Biopsy

Kidney biopsy findings provide the definitive diagnosis and prognostic information; biopsy is indicated if the diagnosis is unclear and when no contraindications are present.

Treatment & Management

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Author

Prasad Devarajan, MD, FAAP Louise M Williams Endowed Chair in Pediatrics, Professor of Pediatrics and Developmental Biology, Director of Nephrology and Hypertension, Director of the Nephrology Fellowship Program, Medical Director of the Kidney Stone Center, Co-Director of the Institutional Office of Pediatric Clinical Fellowships, Director of Clinical Nephrology Laboratory, CEO of Dialysis Unit, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine

Prasad Devarajan, MD, FAAP is a member of the following medical societies: American Heart Association, American Society of Nephrology, American Society of Pediatric Nephrology, National Kidney Foundation, Society for Pediatric Research

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Consultant for Reata, Dicerna, Alnylam<br/>Received none from Coinventor on patents submitted for the use of NGAL as a biomarker of kidney injury for none.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Luther Travis, MD Professor Emeritus, Departments of Pediatrics, Nephrology and Diabetes, University of Texas Medical Branch School of Medicine

Luther Travis, MD is a member of the following medical societies: Alpha Omega Alpha, American Federation for Medical Research, International Society of Nephrology, Texas Pediatric Society

Disclosure: Nothing to disclose.

Chief Editor

Craig B Langman, MD Tenured Professor of Pediatrics, The First Isaac A Abt, MD, Professor of Kidney Diseases (Emeritus), Northwestern University, The Feinberg School of Medicine; Staff Nephrologist, The Ann and Robert H Lurie Children’s Hospital of Chicago

Craig B Langman, MD is a member of the following medical societies: American Academy of Pediatrics, American Federation for Clinical Research, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Pediatric Nephrology, Association of Clinical Scientists, Cochrane Collaboration, International Bone and Mineral Society, International Conferences on Calcium Regulating Hormones, International Pediatric Nephrology Association, International Society of Nephrology, International Society of Renal Nutrition and Metabolism, Midwest Society for Pediatric Research, Pediatric Academic Societies, ROCK (Research on Calculus Kinetics) Society, Society for Pediatric Research

Disclosure: Received income in an amount equal to or greater than $250 from: Alexion Pharmaceuticals; Horizon Pharmaceuticals); ; Dicerna Pharmaceuticals<br/>Incyte Pharmaceuticals; Eli Lilly for: Federation bio; Dicerna pharmaceuticals.

Additional Contributors

Laurence Finberg, MD Clinical Professor, Department of Pediatrics, University of California, San Francisco, School of Medicine and Stanford University School of Medicine

Laurence Finberg, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Elif Erkan, MD, MS, to the development and writing of the source article.