The Diagnosis: Bilateral renal cortical necrosis in meningococcemia

摘要

The abdominal CT showed diagnostic finding of renal cortical necrosis, with non-opacification of the renal cortex (Figure 3, arrows) sparing the subcapsular, juxtamedullary, and medullar areas. The patient deteriorated rapidly despite antibiotic treatment, fluid resuscitation, and hemodialysis, and expired within 11 h of presentation. Her blood culture yielded Neisseria meningitidis 3 days later.Renal cortical necrosis is a rare cause of acute renal failure secondary to ischemic necrosis of the renal cortex caused by vascular spasm, microvascular injury, or intravascular coagulation. Renal cortical necrosis accounts for only 2-4 of all cases of acute renal failure in adults. Renal cortical necrosis is mainly associated with obstetric complications, followed by snake bite, hemolytic uremic syndrome, renalgraft rejection, acute pancreatitis, septicemia, and trauma. Dialysis is required in most survivors. The findings on abdominal CT are often diagnostic, although renal biopsy is the diagnostic gold standard.