1984 Volume 26 Issue 11 Pages 1461-1478
Clinical and pathological features of 30 autopsy cases of renal cortical necrosis (RCN) were reviewed and examined. The following results were obtained : 1) age distribution showed peaks in their fifties and seventies. 2) acute renal failure developed in all cases, but in few cases was noted the existence of RCN clinically. 3) such conditions as infection, hemorrhage, and shock, were associated with development of acute renal failure. 4) increase in serum FDP level and platelet count, and prolongation of prothombin time was noted on laboratory examination. Nine cases out of fully examined 14 cases represented definite DIC (disseminated intravascular coagulation), while the remaining 5 cases showed suspected DIC. 5) as the major pathological conditions, malignancies of various organs were most common at autopsy, while obstetric complication was noted in only one case. 6) mild, moderate, or severe parenchymal necrosis of the renal cortex was disclosed histopathologically in all cases. 7) multiple microthrombi-formation in various organs including the kidneys was detected in all cases except one which was complicated by bilateral contracted kidneys. 8) small focal necrosis was scattered in a few extra-renal organs of all cases except the one, while acute extensive parenchymal necrosis of the extrarenal organs could be found in few cases. 9) RCN without extra-renal lesions was observed in 6 cases. These clinical findings, laboratory data, and results of pathological examination indicated close relationship between RCN and DIC. As DIC could be considered to be a human equivalent of generalized Shwartzman reaction, the relationship might suggest that RCN is caused by the pathomechanism common to both DIC and Shwartzman reaction. Part of the RCN cases might be related to a univisceral or single organ type of Shwartzman reaction.
