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Kidney Week

Abstract: SA-PO937

Pregnancy-Related Complications and Snake Bites Are Leading Causes of Renal Cortical Necrosis in India

Session Information

Category: Pathology and Lab Medicine

  • 1800 Pathology and Lab Medicine

Authors

  • Kurien, Anila Abraham, Renopath Center for Renal and Urological Pathology Pvt Ltd, Chennai, Tamil Nadu, India
  • K.S, Jansi Prema, Renopath Center for Renal and Urological Pathology Pvt Ltd, Chennai, Tamil Nadu, India
  • Cv, Malathi, Renopath Center for Renal and Urological Pathology Pvt Ltd, Chennai, Tamil Nadu, India
  • Caza, Tiffany, Arkana Laboratories, Little Rock, Arkansas, United States
Background

Renal cortical necrosis is present in 1-3% cases of severe acute kidney injury and <1% of kidney biopsies. Due to its relative rarity, potential etiologies are incompletely understood and studies are limited to small series. Here, we present the largest kidney biopsy series of renal cortical necrosis from a study of 227 patients who underwent native kidney biopsy in India.

Methods

Patients who underwent native kidney biopsy from 2013-2023 with a diagnosis of cortical necrosis were identified from the renal pathology archives at the Renopath Center for Renal and Urological Pathology in Chennai, India. Demographics, clinical data, and histopathology were reviewed.

Results

A total of 227 patients with renal cortical necrosis were identified. The mean patient age was 32.2 ± 14.2 years. There was female predominance (75.3%). Of the 227 cases, 150 had concurrent thrombotic microangiopathy (TMA, 66.1%), one had membranous glomerulopathy (0.4%), and one biopsy had a concurrent abscess (0.4%).
A known etiology for cortical necrosis was identified in 170 cases (74.9%). For those with known etiology, 95 were due to pregnancy-related complications (55.9%), 32 from snake bites (19.8%), 13 from acute pancreatitis (7.6%), 8 from sepsis (4.7%), 5 from NSAID-associated papillary necrosis (2.9%), 5 from ingestion of other substances (2.9%), 4 from other animal and insect bites (2.4%), 3 due to non-pregnancy-related post-op complications (1.8%), 2 due to obstruction (1.2%), 2 due to connective tissue disorders (scleroderma and lupus, 1.2%), and one from venous thrombosis. A similar distribution of diagnoses was seen in patients with and without concurrent TMA, with pregnancy-related complications comprising the majority of cases.

Conclusion

Pregnancy-related complications and snake bites were the leading etiologies of renal cortical necrosis from a large kidney biopsy series in India. The majority of cases demonstrated concurrent thrombotic microangiopathy.