Prakash Jai, Singh Vijay Pratap
Jai Prakash, Vijay Pratap Singh, Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, Uttar Pradesh, India.
World J Nephrol. 2015 Nov 6;4(5):480-6. doi: 10.5527/wjn.v4.i5.480.
Renal cortical necrosis (RCN) is characterized by patchy or diffuse ischemic destruction of all the elements of renal cortex resulting from significantly diminished renal arterial perfusion due to vascular spasm and microvascular injury. In addition, direct endothelial injury particularly in setting of sepsis, eclampsia, haemolytic uremic syndrome (HUS) and snake bite may lead to endovascular thrombosis with subsequent renal ischemia. Progression to end stage renal disease is a rule in diffuse cortical necrosis. It is a rare cause of acute kidney injury (AKI) in developed countries with frequency of 1.9%-2% of all patients with AKI. In contrast, RCN incidence is higher in developing countries ranging between 6%-7% of all causes of AKI. Obstetric complications (septic abortion, puerperal sepsis, abruptio placentae, postpartum haemorrhage and eclampsia) are the main (60%-70%) causes of RCN in developing countries. The remaining 30%-40% cases of RCN are caused by non-obstetrical causes, mostly due to sepsis and HUS. The incidence of RCN ranges from 10% to 30% of all cases of obstetric AKI compared with only 5% in non-gravid patients. In the developed countries, RCN accounts for 2% of all cases of AKI in adults and more than 20% of AKI during the third trimester of pregnancy. The reported incidence of RCN in obstetrical AKI varies between 18%-42.8% in different Indian studies. However, the overall incidence of RCN in pregnancy related AKI has decreased from 20%-30% to 5% in the past two decades in India. Currently RCN accounts for 3% of all causes of AKI. The incidence of RCN in obstetrical AKI was 1.44% in our recent study. HUS is most common cause of RCN in non-obstetrical group, while puerperal sepsis is leading cause of RCN in obstetric group. Because of the catastrophic sequelae of RCN, its prevention and aggressive management should always be important for the better renal outcome and prognosis of the patients.
肾皮质坏死（RCN）的特征是由于血管痉挛和微血管损伤导致肾动脉灌注显著减少，引起肾皮质所有成分的局灶性或弥漫性缺血性破坏。此外，直接的内皮损伤，特别是在脓毒症、子痫、溶血性尿毒症综合征（HUS）和蛇咬伤的情况下，可能导致血管内血栓形成，随后出现肾缺血。弥漫性皮质坏死通常会进展为终末期肾病。在发达国家，它是急性肾损伤（AKI）的罕见原因，在所有AKI患者中发生率为1.9%-2%。相比之下，发展中国家RCN的发生率较高，在所有AKI病因中占6%-7%。产科并发症（感染性流产、产褥期脓毒症、胎盘早剥、产后出血和子痫）是发展中国家RCN的主要（60%-70%）病因。其余30%-40%的RCN病例由非产科原因引起，主要是脓毒症和HUS。RCN的发生率在所有产科AKI病例中占10%至30%，而非妊娠患者中仅占5%。在发达国家，RCN占成人所有AKI病例的2%，在妊娠晚期AKI中占20%以上。不同印度研究报告的产科AKI中RCN的发生率在18%-42.8%之间。然而，在过去二十年中，印度与妊娠相关的AKI中RCN的总体发生率已从20%-30%降至5%。目前，RCN占所有AKI病因的3%。在我们最近的研究中，产科AKI中RCN的发生率为1.44%。HUS是非产科组中RCN最常见的病因，而产褥期脓毒症是产科组中RCN的主要病因。由于RCN的灾难性后果，其预防和积极管理对于改善患者的肾脏结局和预后始终至关重要。
