Bilateral Acute Renal Cortical Necrosis in SLE-Associated Antiphospholipid Syndrome

Abstract

Acute renal cortical necrosis (ARCN) is a rare cause of acute kidney injury and is characterized by the entire destruction of the renal cortex. We describe a 16-year-old girl with unremarkable personal or family history who presented with acute anuria and dyspnea. Evaluation showed acute kidney injury associated with metabolic acidosis, hyperkalemia, anemia, thrombocytopenia, hematuria, and proteinuria. Serologic tests showed systemic lupus erythematosus-related antiphospholipid syndrome with low serum complement C3 levels, positive anti-double-stranded DNA antibody, positive antiphospholipid antibody, and positive antinuclear antibody. Contrast-enhanced abdominal computed tomography confirmed the presence of ARCN by showing contrasted medulla and a thin layer of subcapsular cortex, but without bilateral enhancement of the renal cortex. This case shows the role of imaging in patients with bilateral ARCN in systemic lupus erythematosus-related antiphospholipid syndrome.