The core biopsy shows widespread necrosis and interstitial edema.

Focally necrotic glomeruli without thrombosis, and necrotic tubuli are present.

Confluent areas of necrotic tubules are seen, devoid of any nuclei.

Renal cortical necrosis is a rare cause of acute renal failure. Although the pathogenesis remains unclear, intense vasospasm of the small vessels is the presumed underlying cause. In cases of septic abortion or hemolytic uremic syndrome, endotoxin mediated endothelial injury results in thrombosis, causing cortical ischemia and necrosis.

Renal cortical necrosis is most often seeen in the setting of acute hemolytic uremic syndrome in chilren and adolescents, or as an OB complication (pre-eclampsia, abruption, etc) in adult females. It presents with oliguria, hematuria, and flank pain, in classic cases.

Treat the underlying cause, and support hemodynamically. Early initiation of dialysis is recommended for patients with oliguria.

If untreated, up to one half of cases result in mortality.