Case of renal papillary necrosis with severe newborn asphyxia

Abstract

Acute tubular necrosis is well known to develop as an ischemic renal injury in neonates. We experienced a rare case of renal papillary necrosis (RPN). A boy was born with severe asphyxia due to rupture of vasa previa. He had severe anemia, acidemia, and unmeasurable blood pressure, indicating hypovolemic shock. After 2 days of anuria associated with acute kidney injury (AKI), hematuria was observed. Intraurethral catheter was repetitively obstructed by necrotic debris or blood clot, resulting in hydronephrosis. On 14 days after birth, abdominal echo and MRI revealed multiple hemorrhagic cystic lesions in both kidney. The cystic lesions gradually diminished and disappeared. The characteristic images support a diagnosis of renal papillary necrosis. This case is informative to consider the pathogenesis of RPN as ischemic AKI.