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Diagnostic procedures and long-term prognosis in bilateral renal cortical necrosis

1973; Elsevier BV; Volume: 4; Issue: 6 Linguagem: Italiano

10.1038/ki.1973.135

1523-1755

D Kleinknecht, Jean‐Pierre Grünfeld, Pedro Cia Gomez, Jean‐François Moreau, Romano Garcia-torres,

Renal Diseases and Glomerulopathies

Diagnostic procedures and long-term prognosis in bilateral renal cortical necrosis. Thirty-eight patients with bilateral renal cortical necrosis (BRCN) were studied with special reference to etiology, diagnostic procedures and ultimate prognosis. BRCN was of obstetrical origin in 26 patients and more frequent during the third trimester of pregnancy (21%) than earlier (1.5%). Renal biopsy, renal arteriography and hemodynamic data were useful procedures in the early differentiation of total from patchy BRCN. In patients with patchy BRCN, the percentage of destroyed glomeruli on the kidney biopsy specimen was lower than in those with total BRCN, renal arteriography showed that the cortical nephrogram was present but non-homogeneous and mean renal blood flow (MRBF) (85Kr method) fell within the range observed in patients with acute tubular nephropathy undergoing full recovery. In patients with total BRCN, cortical tissue was uniformly necrotic, the cortical nephrogram was completely absent, MRBF was always below 50 ml/100 g·min and a first component was never recognizable. Biological evidence of intravascular coagulation was inconstant. Intrarenal vascular thrombi were only found in the renal biopsy specimens of those patients with short survival. Partial recovery occurred in 16 patients and GFR increased over a one year period. Subsequent deterioration of renal function occurred in nine patients requiring chronic hemodialysis and/or renal transplantation. Diagnostic et pronostic lointain des necroses corticales bilaterales des reins. Trente-huit malades atteints de necrose corticale bilaterale des reins (NCR) ont ete specialement etudies du point de vue de l'etiologie, des methodes de diagnostic et du pronostic lointain. La NCR a ete d'origine obstetricale chez 26 malades et a ete plus souvent observee pendant le troisieme trimestre de la grossesse (21%) que plus precocement (1, 5%). La biopsie renale, l'arteriographie renale et les donnees hemodynamiques ont ete utiles pour distinguer les NCR totales et partielles. Chez les malades atteints de NCR partielle, la biopsie renale a montre que le pourcentage de glomerules detruits etait plus bas que dans les NCR totales, l'arteriographie renale a montre que la nephrographie corticale etait presente mais non-homogene et le flux sanguin renal moyen (FSRM) (methode au 85Kr) restait compris dans les limites observees chez les malades atteints de nephropathie tubulaire aigue avec guerison complete. Chez les malades atteints de NCR totale, le tissu renal cortical etait uniformement necrotique, la nephrographie corticale totalement absente, le FSRM etait toujours inferieur a 50 ml/100 g·mn et aucun premier composant n'etait individualisable. Les preuves biologiques d'une coagulation intravasculaire ont ete inconstantes. Des thrombi vasculaires intrarenaux n'ont ete rencontres en biopsie que chez les malades ayant une courte survie. Une recuperation partielle a ete observee chez 16 malades et la FG a continue a s'elever au-dela de la premiere annee. Une aggravation secondaire de la fonction renale est survenue chez neuf malades, necessit ant des hemodialyses periodiques et/ou une transplantation renale.