CT scan as an important diagnostic tool in the initial phase of diffuse bilateral renal cortical necrosis

Abstract

The serious clinical circumstances and coagulopathy generally accompanied by diffuse bilateral renal cortical necrosis (BRCN), especially during the early period, do not allow renal biopsy being well known as a gold standard diagnostic method for BRCN. Therefore, other noninvasive diagnostic modalities in the initial phase of BRCN have been tried, and, among them, contrast-enhanced computerized tomography (CT) was found to provide very characteristic representative findings, i.e., low attenuation of cortex sparing thin rim of subcapsular cortex and medulla, correlating well with histological findings of renal biopsy performed in the late somewhat stable clinical status or at autopsy. These specific CT findings were reported consistently with or without renal biopsy in several articles recently. Herein, we present a 38-year-old woman of massive automobile accident victim, developed protracted total anuria as well as shock with disseminated intrasvascular coagulation (DIC), and diagnosed as BRCN by the specific CT findings without renal biopsy in the second day of admission. Simultaneously, all the scattered cases of BRCN diagnosed by CT are reviewed and contrast to the findings of other diagnostic procedures performed for the same cases. The importance of contrast-enhanced CT as noninvasive diagnostic procedure during the initial phase of BRCN is stressed.