ACUTE RENAL CORTICAL NECROSIS - A STUDY OF 113 PATIENTS

Over a 28-year period, 113 out of 2986 (3.8%) patients dialysed for ac ute renal failure at a referral center in North India were diagnosed t o have acute renal cortical necrosis (ACN). Obstetric causes were resp onsible for ACN in 56.6% patients and nonobstetric causes in 43.4%. Wi thin the obstetric group, ACN developed in association with complicati ons of late pregnancy in 37.1% and following septic abortion in 19.5%. The various nonobstetric causes included viperine snake bite in 14.2% , hemolytic uremic syndrome in 11.5%, renal allograft rejection in 5.3 %, acute gastroenteritis in 4.4%, acute pancreatitis in 3.5%, septicem ia in 2.7%, and trauma and drug-induced IV hemolysis in 0.9% patients. Total anuria was the commonest presenting feature and war noted in 78 .8% of patients. Renal histology showed diffuse cortical necrosis in 6 2.8% and patchy lesions in 37.2% patients. Computerized tomography (CT scan) of the kidneys revealed characteristic diagnostic findings in a ll the 5 patients in whom it was done. Dialytic support could be withd rawn as a result of improvement in renal function in 19 patients with patchy cortical necrosis. Dialysis-free survival of as long as 12 year s has been recorded. The present study shows that, in contrast to the Western world, ACN continues to be a common cause of acute renal failu re in developing countries. CT scan of the kidneys is helpful in estab lishing an early diagnosis.