Chapter 528 Cortical Necrosis
Renal cortical necrosis is a rare cause of acute renal failure occurring secondary to extensive ischemic damage of the renal cortex. It occurs most commonly in neonates and in adolescents of childbearing age.
Etiology
In newborns, cortical necrosis is most commonly associated with hypoxic or ischemic insults caused by perinatal asphyxia, placental abruption, and twin-twin or fetal-maternal transfusion. Other causes include renal vascular thrombosis and severe congenital heart disease. After the neonatal period, cortical necrosis is most commonly seen in children with septic shock or severe hemolytic-uremic syndrome. In adolescents and women, cortical necrosis occurs in association with obstetric complications including septic abortion and intrauterine fetal demise.
Less-common causes of cortical necrosis include extensive burns, snakebite, infectious endocarditis, and medications (e.g., nonsteroidal anti-inflammatory agents).
Epidemiology
Renal cortical necrosis is a rare disease entity accounting for only 2% of all cases of acute renal failure in developed countries. The incidence is higher in developing countries.
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