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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2021  |  Volume : 32  |  Issue : 1  |  Page : 271-272
Biopsy or Computerized Tomography Scan to Diagnose Postpartum Acute Cortical Necrosis: Time to Rethink


1 Department of Nephrology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
2 Department of Radiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

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Date of Web Publication16-Jun-2021
 

How to cite this article:
Chandra A, Rao N, Kumar T. Biopsy or Computerized Tomography Scan to Diagnose Postpartum Acute Cortical Necrosis: Time to Rethink. Saudi J Kidney Dis Transpl 2021;32:271-2

How to cite this URL:
Chandra A, Rao N, Kumar T. Biopsy or Computerized Tomography Scan to Diagnose Postpartum Acute Cortical Necrosis: Time to Rethink. Saudi J Kidney Dis Transpl [serial online] 2021 [cited 2021 Dec 8];32:271-2. Available from: https://www.sjkdt.org/text.asp?2021/32/1/271/318539


To the Editor,

Postpartum acute cortical necrosis (ACN), though rare and declining in incidence, is still an important cause of renal failure.[1] It is caused by an ischemic damage to the renal tissue due to a vascular injury. This is usually due to the poor blood supply, vascular spasm, or intra-vascular coagulation involving interlobular arteries and afferent arterioles. As a result of this insult, only a thin rim of subcapsular, juxtamedullary areas and medulla are spared. Definite diagnosis requires a renal biopsy which also has prognostic value. Contrast-enhanced computed tomography (CT) scan has a good sensitivity to diagnose ACN by features such as lack of enhancement of renal cortical tissue, well-enhanced renal medulla, and absence of contrast excretion.[2] In most cases, it is the renal biopsy which has been reported as the means to diagnose such cases.[3]

However, the point of concern is how safe is renal biopsy in these patients. Here, we report nine cases of postpartum acute renal cortical necrosis who underwent renal biopsy from January 2016 to 2019. All cases had advance degree of renal failure and underwent multiple sessions of hemodialysis (without heparin) before biopsy. The duration of renal failure ranged between four and five weeks. Blood transfusions were done to ensure a hemoglobin close to 9 g/dL at the time of renal biopsy. All had a blood pressure of ≤140/90 mm Hg at the time of biopsy. Coagulation parameters were within normal limits in all the patients. We encountered severe bleeding manifestations in three of the cases. One had to undergo vascular embolization to stop the ongoing bleed along with multiple blood transfusions [Table 1]. The other two cases were managed conservatively with blood transfusion alone. The necrosis was patchy in two cases where biopsy was uneventful. The increased risk of bleeding in these cases could stem from the fact that the necrotic tissue fails to effectively seal the biopsy puncture site as a normal tissue does. There is hardly any study in the literature that has exclusively reported renal biopsy complications in cases of similar nature. This raises an important question whether we can completely avoid invasive renal biopsy and do a contrast CT scan first in suspected cases of CAN considering the high degree of sensitivity it offers.[4] In our view, renal biopsy should only be considered when CT scan is inconclusive or when the need of prognostication is there.
Table 1: Demographic table.

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Conflict of interest: None declared.



 
   References Top

1.
Prakash J, Pant P, Singh AK, Sriniwas S, Singh VP, Singh U. Renal cortical necrosis is a disappearing entity in obstetric acute kidney injury in developing countries: Our three decade of experience from India. Ren Fail 2015;37:1185-9.  Back to cited text no. 1
    
2.
Jordan J, Low R, Jeffrey RB Jr. CT findings in acute renal cortical necrosis. J Comput Assist Tomogr 1990;14:155-6.  Back to cited text no. 2
    
3.
Pahwa N, Bharani R, Kumar R. Post-partum acute kidney injury. Saudi J Kidney Dis Transplant 2014;25:1244-7.  Back to cited text no. 3
    
4.
Kim HJ. Bilateral renal cortical necrosis with the changes in clinical features over the past 15 years (1980-1995). J Korean Med Sci 1995;10:132-41.  Back to cited text no. 4
    

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Correspondence Address:
Namrata Rao
Department of Nephrology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh
India
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DOI: 10.4103/1319-2442.318539

PMID: 34145146

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