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Images in Nephrology
19 (
3
); 125-125
doi:
10.4103/0971-4065.57112

Bilateral renal cortical necrosis in acute pancreatitis

Department of Radiology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh-517 501, India
Department of Nephrology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh-517 501, India
Address for correspondence: Dr. V. Siva Kumar, Department of Nephrology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, A.P-517 501, India. E-mail: sa_vskumar @yahoo.com
Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications and was migrated to Scientific Scholar after the change of Publisher.

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 20-96 U/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.

Figure 1
Contrast enhanced CT of the abdomen showing diffuse hypodense areas in the cortex surrounded by capsular enhancement in both the kidneys

Discussion

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.[23] Interestingly, our patient was normotensive through out. In view of its rarity, this entity is reported.

References

  1. , , , . Acute renal cortical necrosis: a study of 113 patients. Ren Fail. 1994;16:37-47.
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  2. , , . Acute renal failure following necrotico hemorrhagic pancreatitis. Kidney Int. 2008;74:975-6.
    [Google Scholar]
  3. , , , . Acute pancreatitis and Renal cortical necrosis. Nephrol Dial Transplant. 1990;5:542-4.
    [Google Scholar]

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