# Unilateral renal cortical necrosis

## TL;DR

A 51-year-old woman developed unilateral renal cortical necrosis following sepsis and disseminated intravascular coagulation.

## Contribution

This case report adds to the rare literature on unilateral renal cortical necrosis associated with septic shock and hydronephrosis.

## Key findings

- Unilateral renal cortical necrosis occurred alongside contralateral hydronephrosis and septic shock.
- Gram-negative sepsis with Proteus was confirmed, along with disseminated intravascular coagulation.
- Only two prior cases of this specific clinical presentation have been reported.

## Abstract

A 51-year-old woman presented to her local emergency department with acute onset right-sided flank pain and nausea. Her blood results on admission were largely unremarkable aside from leucocytosis and neutrophilia. Two days after admission, she developed the following: stage 3 AKI with oliguria, anaemia, thrombocytopenia, and acute derangement of liver function tests. A computed tomography of the kidney ureter bladder demonstrated a right-sided 4 mm obstructing vesicoureteric junction stone with associated hydronephrosis and hydroureter. She was transferred to a tertiary care centre; gram negative sepsis was confirmed with a Proteus on blood culture and laboratory findings were in keeping with DIC.

She was treated with Tazobactam/Piperacillin and intravenous fluids. In addition, further imaging showed improving right-sided hydronephrosis and left renal cortical necrosis. The aetiology of this presentation was sepsis complicated by disseminated intravascular coagulation. The coagulopathy likely contributed to the unilateral renal cortical necrosis.

Cortical necrosis usually affects both kidneys, and is typically a complication of sepsis, shock, or obstetrical trauma. To our knowledge, there are only 2 reported cases of unilateral renal cortical necrosis and contralateral hydronephrosis with renal colic and septic shock. Potential pathogenetic mechanisms are discussed.