Unilateral renal cortical necrosis

Area of Science:

• Nephrology
• Critical Care Medicine
• Infectious Diseases

Background:

• Acute kidney injury (AKI) and sepsis are common critical care emergencies.
• Disseminated intravascular coagulation (DIC) is a life-threatening condition characterized by abnormal blood clotting.
• Renal cortical necrosis is a rare but severe kidney injury, typically bilateral.

Observation:

• A 51-year-old woman presented with flank pain, progressing to stage 3 AKI, anemia, thrombocytopenia, and liver dysfunction.
• Imaging revealed a ureteric stone causing hydronephrosis, complicated by gram-negative sepsis (Proteus) and DIC.
• Despite treatment, she developed unilateral renal cortical necrosis in the left kidney with improving right-sided hydronephrosis.

Findings:

• Sepsis secondary to a ureteric stone complicated by DIC was the primary cause.
• The coagulopathy associated with DIC likely contributed to the unilateral renal cortical necrosis.
• This case represents one of only two reported instances of unilateral renal cortical necrosis with contralateral hydronephrosis, septic shock, and renal colic.

Implications:

• This case underscores the potential for sepsis-induced DIC to cause unilateral renal cortical necrosis.
• Understanding the pathogenetic mechanisms is crucial for managing similar rare clinical scenarios.
• Highlights the importance of prompt diagnosis and management of urosepsis and associated coagulopathies.