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IMAGES IN NEPHROLOGY
Year : 2009  |  Volume : 19  |  Issue : 3  |  Page : 125
 

Bilateral renal cortical necrosis in acute pancreatitis


1 Department of Radiology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh-517 501, India
2 Department of Nephrology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh-517 501, India

Date of Web Publication15-Oct-2009

Correspondence Address:
V Siva Kumar
Department of Nephrology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, A.P-517 501
India
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DOI: 10.4103/0971-4065.57112

PMID: 20436735

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How to cite this article:
Krishna G, Kishore K C, Sriram N P, Sainaresh V V, Lakshmi A Y, Kumar V S. Bilateral renal cortical necrosis in acute pancreatitis. Indian J Nephrol 2009;19:125

How to cite this URL:
Krishna G, Kishore K C, Sriram N P, Sainaresh V V, Lakshmi A Y, Kumar V S. Bilateral renal cortical necrosis in acute pancreatitis. Indian J Nephrol [serial online] 2009 [cited 2014 Dec 28];19:125. Available from: http://www.indianjnephrol.org/text.asp?2009/19/3/125/57112


A 22-year-old male with no premorbid illness presented to emergency with vomiting, peri umbilical abdominal pain with pain radiating to the back following an alcoholc binge. He developed oliguria followed by anuria over two days. On examination, he was hemodynamically stable (BP - 120/80 mm of Hg) and had tenderness in the epigastrium and right hypochondriac areas. Investigations revealed neutrophilic leucocytosis (14200 per μl), severe renal failure (Serum creatinine: 13.4 mg/dl) and elevated pancreatic enzymes (serum amylase: 397 U/L, lipase 210 U/L, normal values being 20-96U/L and 3-43 U/L respectively), elevated LDH (1802 U/L, normal being 115-221 U/L). Contrast enhanced Computed tomography of the abdomen [Figure 1] revealed diffuse and bilateral cortical hypodense areas surrounded by capsular enhancement in both kidneys, which is characteristic of renal cortical necrosis. He received general supportive management, antibiotics and dialysis support. Patient left the hospital against advice on the third hospital day.


  Discussion Top


Bilateral cortical necrosis is a rare, often irreversible form of acute tubular necrosis. In a study on acute renal failure from north India, the incidence reported was 3.8%. [1] Only eight cases of bilateral cortical necrosis following acute pancreatitis were reported so far in the literature. [2] Cortical necrosis generally results from decreased blood supply within the microcirculation of renal cortex that follows septic shock or volume depletion. However, its cause remains elusive in the presence of normotension. It was ascribed to the release of vasoactive or cytotoxic substances during pancreatitis. [2],[3] Interestingly, our patient was normotensive through out. In view of its rarity, this entity is reported.

 
  References Top

1.Chugh KS, Jha V, Sakhuja V, Joshi K. Acute renal cortical necrosis: a study of 113 patients. Ren Fail 1994;16:37-47.  Back to cited text no. 1  [PUBMED]    
2.Goffin EJ, Coche EE, Lambert MJ. Acute renal failure following necrotico hemorrhagic pancreatitis. Kidney Int 2008;74:975-6.   Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Fox JG, Sutcliffe NP, Boulton-Jones JM, Imrie CW. Acute pancreatitis and Renal cortical necrosis. Nephrol Dial Transplant 1990;5:542-4.  Back to cited text no. 3  [PUBMED]    


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Indian Journal of Nephrology
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