renal cortical necrosis

腎皮質壊死

WordNet

1. of or relating to a cortex
2. the localized death of living cells (as from infection or the interruption of blood supply) (同)mortification, gangrene, sphacelus

PrepTutorEJDIC

1. 皮質から成る,皮質の,(特に)大脳皮質の
2. 壊疽(えそ)
3. 腎臓の

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/05/01 20:18:56」(JST)

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Acute Cortical Necrosis
Classification and external resources
ICD-10	N17.1
ICD-9	583.6
eMedicine	article/983599 at eMedicine

Renal cortical necrosis (RCN, also diffuse bilateral renal cortical necrosis (BRCN), diffuse cortical necrosis, acute cortical necrosis, or acute renal failure with acute cortical necrosis) is a rare cause of acute renal failure. The condition is "usually caused by significantly diminished renal arterial perfusion secondary to vascular spasm, microvascular injury, or [disseminated] intravascular coagulation" and is the pathological progression of acute tubular necrosis. It is frequently associated with obstetric catastrophes such as abruptio placentae and septic shock, and is three times more common in developing nations versus industrialized nations (2% versus 6% in causes of acute renal failure).^{[citation needed]}

Causes

In adults

• Pregnancy related (>50% of cases)
  • Placental abruption
  • Infected abortion
  • Prolonged intrauterine fetal death
  • Severe eclampsia
• HIV
• Snake bites
• Binge drinking
• Shock
• Trauma
• Sickle cell disease
• Systemic lupus erythematosus (SLE)
• Sepsis
• SLE-associated antiphospholipid syndrome
• Vitamin deficiency
• Pancreatitis
• Malaria
• Meningococcemia
• Drug-induced toxicity (e.g. NSAIDs, Contrast Media, Quinine, or ATRA)

Neonatal

• Congenital heart disease
• Fetal-maternal transfusion
• Dehydration
• Perinatal asphyxia
• Anemia
• Placental hemorrhage
• Severe hemolytic disease
• Sepsis

Pathophysiology

The exact pathologic mechanism for RCN is unclear, however the onset of small vessel pathology is likely an important aspect in the etiology of this condition. In general the renal medulla is under greater oxygen tension and more prone to ischemic injury, especially at the level of the proximal collecting tubule, leading to its preferential damage in a sudden drop in perfusion. Rapidly corrected acute renal ischemia leads to acute tubular necrosis, from which complete recovery is possible, while more prolonged ischemia may lead to RCN. Pathologically, the cortex of the kidney is grossly atrophied with relative preservation of the gross structure of the medulla. The damage is usually bilateral owing to its underlying systemic causes, and is most frequently associated with pregnancy (>50% of cases). It accounts for 2% of all cases of acute renal failure in adults and more than 20% of cases of acute renal failure during late pregnancy.

Diagnosis

While the only diagnostic "gold standard" mechanism of diagnosis en vivo is via renal biopsy, the clinical conditions and blood clotting disorder often associated with this disease may make it impractical in a clinical setting. Alternatively, it is diagnosed clinically, or at autopsy, with some authors suggesting diagnosis by contrast enhanced CT.

Treatment

Patients will require dialysis to compensate for the function of their kidneys.

Prognosis

Cortical necrosis is a severe and life threatening condition, with mortality rates over 50%.^{[citation needed]} Those mortality rates are even higher in neonates with the condition due to the overall difficult nature of neonatal care and an increased frequency of comorbid conditions. The extent of the necrosis is a major determinant of the prognosis, which in turn is dependent on the duration of ischemia, duration of oliguria, and the severity of the precipitating conditions. Of those that survive the initial event, there are varying degrees of recovery possible, depending on the extent of the damage.

References

UpToDate Contents

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• 1. 妊娠における急性腎障害（急性腎不全） acute kidney injury acute renal failure in pregnancy
• 2. 虚血後（虚血性）の急性尿細管壊死の発症および病因 pathogenesis and etiology of postischemic ischemic acute tubular necrosis
• 3. 非乏尿性と乏尿性の急性尿細管壊死の比較 nonoliguric versus oliguric acute tubular necrosis
• 4. 尿路閉塞および水腎症の臨床症状および診断 clinical manifestations and diagnosis of urinary tract obstruction and hydronephrosis
• 5. 成人における血栓性血小板減少性紫斑病-溶血性尿毒症症候群の原因 causes of thrombotic thrombocytopenic purpura hemolytic uremic syndrome in adults

English Journal

• Proliferative capacity of stem/progenitor-like cells in the kidney may associate with the outcome of patients with acute tubular necrosis.

• Ye Y, Wang B, Jiang X, Hu W, Feng J, Li H, Jin M, Ying Y, Wang W, Mao X, Jin K.SourceDepartment of Nephrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang 310016, China.
• Human pathology.Hum Pathol.2011 Aug;42(8):1132-41. Epub 2011 Feb 11.
• Animal studies indicate that adult renal stem/progenitor cells can undergo rapid proliferation in response to renal injury, but whether the same is true in humans is largely unknown. To examine the profile of renal stem/progenitor cells responsible for acute tubular necrosis in human kidney, double
• PMID 21315412

• Histopathological changes in gerbil liver and kidney after aluminum subchronic intoxication.

• Garrosa M, Llanes F, Gayoso MJ.SourceDepartment of Cell Biology, Histology and Pharmacology, Faculty of Medicine, INCYL, University of Valladolid, Valladolid, Spain. garrosa@med.uva.es
• Histology and histopathology.Histol Histopathol.2011 Jul;26(7):883-92.
• Young gerbil livers and kidneys were analyzed by means of light and electron microscope to assess the histopathological changes caused by prolonged systemic aluminum (Al) administration. The experimental group was injected with AlCl3 i.p. for 5 weeks, while litter mates received PBS as sham-injected
• PMID 21630218

Japanese Journal

• Natural Occurrence of Grape Poisoning in Two Dogs

• YOON Soon-Seek,BYUN Jae-Won,KIM Min-Jeong,BAE You-Chan,SHIN Yeun-Kyung,YOON Sorah,LEE Garam,SONG Jae-Young
• Journal of Veterinary Medical Science 73(2), 275-277, 2011
• … Brownish-yellow crystals were bilaterally identified in the renal pelvis. … The primary histological findings were acute tubular necrosis of the proximal convoluted tubules, severe necrosis, and mineralization in the renal cortical tubules. …
• NAID 130000444195

• Acute Bilateral Renal Cortical Necrosis Complicating Pyomyoma

• Kuriyama Katsutoshi,Makiishi Tetsuya,Maeda Sayako,Konishi Takashi,Hirose Kunihiko
• Internal Medicine 49(5), 511-512, 2010
• NAID 130000251708

Related Links

• Renal Cortical Necrosis

26 May 2011 ... Renal cortical necrosis is a rare cause of acute renal failure secondary to ischemic necrosis of the renal cortex.

Related Pictures

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★リンクテーブル★

リンク元	「腎皮質壊死」「glomerular necrosis」
関連記事	「cortical」「renal」「renal cortical」

「腎皮質壊死」

　　[★]

英

renal cortical necrosis、kidney cortex necrosis

関

糸球体壊死 glomerular necrosis

病理

• 腎臓の皮質が壊死に陥る。糸球体、輸入細動脈、小葉間動脈、弓状動脈に血栓が形成され、糸球体、尿細管、および間質が壊死に陥る。

原因

• 産科的合併症(胎盤早期剥離、流産)、DIC、腎硬化症、急性アルコール中毒 (YN.E-72)
• 周産期の腎循環不全、新生児期の消化管破裂 (SPE.603)

症状

• 急性腎不全
• 高度の代謝性アシドーシス

予後

• 不良。回復しても糸球体障害や尿細管機能障害を残す。

「glomerular necrosis」

　　[★]

• 糸球体壊死

関

kidney cortex necrosis、renal cortical necrosis

「cortical」

　　[★]

• adj.

• 皮質性の、皮質の、皮層の

関

cortex、cortical layer、cortically、cortices、cortico

　 　

「renal」

　　[★]

• adj.

• 腎臓の、腎性の、腎の

関

kidney、renally

　

「renal cortical」

　　[★]

• 腎皮質の

関

kidney cortex、renal cortex