Renal cortical necrosis (RCN) is a rare cause of acute renal

Renal cortical necrosis (RCN) is a rare cause of acute renal failure (ARF). case report of RCN in a live kidney donor in world literature. Keywords: Acute renal failure hemolytic uremic syndrome live kidney donor renal cortical necrosis Introduction Renal cortical necrosis (RCN) is usually a rare entity and is secondary to ischemic necrosis of renal cortex caused by vascular spasm microvascular injury or intravascular coagulation. RCN accounts for 3% of all cases of acute kidney injury (AKI) in adults.[1] Obstetric and nonobstetrical causes account for 50 to 70% and 20 to 30% cases of RCN respectively.[1-3] Severe sepsis with shock is the PD173074 most common (30-40%) nonobstetrical cause of RCN.[2 3 Drug-induced thrombotic microangiopathy is an important cause of RCN.[4 5 However RCN has not been previously reported in a live kidney donor. Case Report A 48-year-old normotensive nondiabetic healthy female donor was admitted for left nephrectomy for kidney transplantation to her daughter. Computed tomography (CT) renal angiography showed normal kidneys and urinary tracts as well as normal renal arteries originating from the aorta and branching well into the renal parenchyma [Physique ?[Physique1a1a and ?andb].b]. Diethylene-triamine-penta-acetic acid (DTPA) scan revealed total glomerular filtration rate (GFR) of 100.1 ml/min with differential function of 51.8% and 48.2% for the right and left kidneys respectively. Left nephrectomy was done and was transplanted successfully to the recipient. The donor was hemodynamically stable throughout the operation. The medications used during the operation were glycopyrrolate vecuronium propofol isoflurane nitrous oxide neostigmine bupivacaine fentanyl furosemide 120 mg and mannitol 70 g (350 ml of 20% answer). She received total of 5200 ml PD173074 of fluid and urine output was 3400 ml during the time she was in operation theater for 2 hours. The surgery was uneventful as was the immediate postoperative recovery from anesthesia. She did well with urine output of >1.48 l/h for 2 hours and 1.25 l/h in subsequent 2 hours. In the fifth postoperative hour her urine output decreased to 750 ml/h and subsequently to 50-60 ml/h in sixth and seventh hours after surgery and she became anuric at eighth postoperative hour. After ruling out catheter obstruction and dehydration she was given furosemide infusion at 60 mg/h which resulted in only 110 ml of urine output in next 2 hours followed by no output. Doppler study revealed patent renal vessels PD173074 with good blood flow and absence of obstruction of urinary tract. Around the first postoperative day (POD) she was hemodialyzed for 3 hours because of fluid overload. Laboratory investigations on POD1 revealed hemoglobin of 7.7 g/ dl thrombocytopenia leukocytosis hyperbilirubinemia elevated lactate dehydrogenase (LDH) (1222 IU/l) and INR of 1 1.12. Peripheral PD173074 smear revealed anisocytosis and few normoblasts with fragmented red blood cells PD173074 (RBCs). In view of low platelet count raised LDH drop in hemoglobin along with normal INR a diagnosis of hemolytic uremic syndrome (HUS) was made [Table 1]. She was transfused with two models of whole blood on POD3 due to drop in hemoglobin concentration to 5.3 g/dl. Chest X-ray on POD3 showed right lower zone pneumonia and she was treated Rabbit polyclonal to ACC1.ACC1 a subunit of acetyl-CoA carboxylase (ACC), a multifunctional enzyme system.Catalyzes the carboxylation of acetyl-CoA to malonyl-CoA, the rate-limiting step in fatty acid synthesis.Phosphorylation by AMPK or PKA inhibits the enzymatic activity of ACC.ACC-alpha is the predominant isoform in liver, adipocyte and mammary gland.ACC-beta is the major isoform in skeletal muscle and heart.Phosphorylation regulates its activity.. with cefpirome 2 g/day ofloxacin 200 mg/time and azithromycin 250 mg OD. She became afebrile on POD4. Her upper body infections improved; thrombocytopenia raised LDH and bilirubin became regular; and leucocytosis demonstrated a downward craze at POD11. Body 1 Kidney ureter and renal vessels of living donor (Mom). (a) Volume-rendered (VR) picture showing regular kidneys and urinary tracts bilaterally; (b) Optimum strength of projection (MIP) displaying bilateral regular renal arteries from aorta … Desk 1 Clinical features of kidney donor pursuing nephrectomy Because of consistent anuria she was put through contrast-enhanced CT (CECT) check of abdominal on POD28 which uncovered features of severe RCN in correct kidney [Body ?[Body1c1c and ?andd].d]. She was discharged on POD30 with great BP control on amlodipine (15 mg/time) and clonidine (0.3 mg/day) and informed to keep maintenance hemodialysis. At two-month follow-up her antihypertensive necessity reduced as well as her urine output increased to 125 ml/day and at the end of fourth month her urine output was 400 ml/ day. Three months after operation she developed right lower lobe pneumonitis which.