Renal Cortical Necrosis Workup

Updated: Nov 03, 2015
  • Author: Prasad Devarajan, MD, FAAP; Chief Editor: Craig B Langman, MD  more...
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Workup

Approach Considerations

The diagnostic characteristics of renal cortical necrosis can be detected via the following [11] :

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

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CBC

A CBC may reveal hemolytic anemia and thrombocytopenia.

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Coagulation Studies

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

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Urinalysis

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

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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.

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Ultrasonography

The ultrasonogram initially shows enlarged kidneys with reduced blood flow. [12] Cortical tissue becomes shrunken later in disease progression.

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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. [13]

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.

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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.

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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.

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