Cortical necrosis

Acute cortical necrosis Drug dosing of renally cleared agents Chronic interstitial nephritis... 

Concentrated sodium chloride injection Inadvertent direct injection or absorption of concentrated sodium chloride injection may give rise to sudden hypernatremia and such complications as cardiovascular shock, CNS disorders, extensive hemolysis, cortical necrosis of the kidneys, and severe local tissue necrosis (if administered extravascularly). Do not use unless solution is clear. When administered peripherally, slowly infuse through a small bore needle placed well within the lumen... 

Laminar cortical necrosis is the end-stage of cortical ischemia and has been described in many conditions of cellular energy depletion, such as hypoxia and hypoglycemia. It may also be associated with a variety of other diseases affecting the nervous system (Valanne et al. 1996). Laminar cortical necrosis has been studied with nuclear medicine methods (Hawes and Mishkin 1972), but has recently been more extensively studied with CT and MRI. 

In a study of six patients with laminar cortical necrosis, MRI showed hyperintense lesions in the cerebral cortex on Tl-weighted and T2-weighted images (el Quessar et al. 1999). In four patients,... 

Fig. 16.5a-d. The late imaging shows diffuse cortical necrosis seen as areas of hyperintensity on T2-weighted imaging (a, d). Proton density image is shown in (b). There are also the typical Tl-weighted hyperintensities in the parietal cortex bilaterally (arrows, c)... 

Diffusion-weighted MRI, due to its extreme sensitivity to changes in tissue water and, therefore, to ischemia (Le Bihan et al. 1986 Moseley et al. 1990 van Gelderen et al. 1994 Warach et al. 1992,1995 Sorensen et al. 1996 Lovblad et al. 1998), makes it possible to demonstrate ischemic changes due to acute hypoperfusion (see Chap. 7). These findings correspond to those found in the early stages of laminar cortical necrosis (Figs. 16.3, 16.6, 16.7). 

Fig. 16.10a-d. A 66-year-old man found comatose after severe intoxication. The neuropathological findings show diffuse cortical necrosis (recent, a) the arrows indicate that edema predominates in the depth of the sulci. There are shrunken neurons with eosinophilic cytoplasm and pyknotic nuclei (b, c). The cerebellar cortex shows shrunken necrotic Purkinje cells (d)... 

Hawes DR, Mishkin FS (1972) Brain scans in watershed infarction and laminar cortical necrosis. Radiology 103 131-134... 

Valanne L, Paetau A, Suomalainen A, Ketonen L, Pihko H (1996) Laminar cortical necrosis in MELAS syndrome MR and neuropathological observations. Neuropediatrics 27 154-160... 

Renal Proximal tubule degeneration, papillary and cortical necrosis... 

Baumgartner H, Scheithn W, von Rechenberg HK. [Bilateral renal cortical necrosis following pyrazolone treatment.] Dtsch Med Wochenschr 1967 2(23) 1075-7. 

Irreversible renal insufficiency due to acute cortical necrosis triggered by severe renal hypoperfusion has been reported (SEDA-12, 86). A pharmacokinetic study showed that conversion of inactive R-ibuprofen to active 5-ibuprofen was greater in patients with renal impairment than in healthy controls this may aggravate renal insufficiency (21). 

Headache, drowsiness, and dizziness are common with niridazole (2,4,5). More severe neuropsychiatric symptoms are more frequent in patients with liver disease, especially those with portosystemic shunts, in whom the drug bypasses the liver (6). Symptoms in these cases include insomnia, anxiety, depression, confusion, hallucinations, and convulsions the reactions may prove fatal. The electroencephalogram can show slowed alpha rhythms, beta waves, and theta waves, as well as sharp wave and spike forms with niridazole (7). A single case of acute cortical necrosis was recorded in the much older literature, but was probably coincidental (SED-8, 691) (8). Agitation can occur in patients with abnormal liver function. 

The combination of renal insufficiency with cortical necrosis, thrombocjhopenia, intravascular coagulation, and deposition of fibrin was seen in a 63-year-old woman who had drunk tonic water. She had had two previous episodes of acute renal insufficiency also associated with quinine-containing drinks this most certainly reflected a hjrpersensitivity reaction (SEDA-13, 815). 

Renal damage accompanies acute hemolysis due to quinine. Renal insufficiency in cases of quinine poisoning is probably due to circulatory collapse. Allergic reactions underlie at least some cases. The picture can be complex, with the renal insufficiency coming in association with cortical necrosis, thrombocytopenia, intravascular coagulation, and deposition of fibrin. 

Acute renal cortical necrosis has been attributed to tranexamic acid in a patient with hemophiha A (49,50). 

A 21-year-old man developed oliguria and uremia after 3 days of treatment with tranexamic acid 3 g/day for epistaxis. He did not recover. Renal angiography showed reduced cortical contrast enhancement, compatible with renal cortical necrosis. No other susceptibihty factors for renal cortical necrosis were present. 

Renal impairment associated with acute renal cortical necrosis caused by tranexamic acid is rare. The authors found only three previously reported cases in English, of which at least one other was without any known susceptibility factor for acute renal cortical necrosis (49). 

Odabas AR, Cetinkaya R, Selcuk Y, Kaya H, Coskun U. Tranexamic-acid-induced acute renal cortical necrosis in a patient with haemophilia A. Nephrol Dial Transplant 2001 16(1) 189-90. 

Cortical necrosis—Acute renal failure secondary to ischemic necrosis of the renal cortex usually caused by significantly diminished renal arterial perfusion. 

Waugh, D. and Pearl, M. J., Serotonin-induced acute nephrosis and renal cortical necrosis in rats. A morphologic study with pregnancy correlation, Am.. Pathol., 36, 431, 1960. 

Kumar et al. (1994) exposed mice to an average CR concentration of 1008 mg m 3 daily for 15 minaday for lOdays. At5days, lungs demonstrated minimal alveolar haemorrhage and after 10 days there was moderate alveolar haemorrhage and alveolar capillary congestion and a few foci of renal cortical necrosis. 

Muller NG, Gruber O High-resolution magnetic resonance imaging reveals symmetric bitemporal cortical necrosis after carbon monoxide intoxication. J Neuroimaging 11 322-325, 2001... 

Massive and transient thrombi in the kidney only induce temporary oliguria and azotemia, but the persistence of renal thrombi leads to tubular necrosis and bilateral cortical necrosis. 

Page, I. H. and Glendening, M. B., Production of renal cortical necrosis with serotonin (5-hydroxytryptamine), Obstetr. Gynecol. 5, 781 (1955). 

Cerebral cortical necrosis and poliomalacia may occur in cattle. Neuronal necrosis and hyaline changes in arterioles are inconsistent lesions. 

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