대한신장학회

논문분류	춘계학술대회 초록집
제목	Double Trouble: A Case Series on Postpartum Renal Cortical Necrosis in Twin Pregnancies With Varied Outcomes
저자	Akshaya J
출판정보	2025; 2025(1):
키워드	Pregnancy, Acute Kidney Injury, Cortical necrosis, Pr-AKI, Twins/artifical reproduction
초록	Renal cortical necrosis (RCN) is a severe form of pregnancy-associated acute kidney injury (Pr-AKI), frequently necessitating renal replacement therapy often triggered by postpartum hemorrhage (PPH), pre-eclampsia, and TMA. This case series retrospectively analyzed four patients with twin pregnancies and biopsy-proven RCN between 2023 and 2024. The study aimed to evaluate obstetric and renal outcomes, therapeutic interventions, and long-term renal function. All four patients were primigravidas in their late 20s to early 30s, with a history of infertility or recurrent miscarriages. Three conceived via assisted reproductive techniques (ART), and all delivered via lower segment cesarean section (LSCS). Each patient developed RCN following severe obstetric complications, including PPH, pre-eclampsia, HELLP syndrome, and bowel rupture. Renal biopsy and imaging confirmed RCN in all cases. Outcomes varied: one patient achieved complete renal recovery after prolonged dialysis, one had partial recovery and discontinued dialysis, and two progressed to end-stage kidney disease (ESKD), with one requiring ongoing dialysis and the other receiving a live-related donor renal transplant. This series highlights the heterogeneity of RCN outcomes, emphasizing that even in cases with significant chronicity on biopsy, late renal recovery is possible. Close follow-up is crucial to identify recovery and preserve residual renal function. The study also reveals that RCN, while often associated with poor outcomes, can have variable trajectories, and a subset of patients may regain renal function even after months of dialysis dependence. This challenges the notion that RCN invariably leads to irreversible kidney damage and highlights the need for individualized patient management. Early renal biopsy and imaging are critical for accurate diagnosis. In conclusion, RCN remains a devastating complication of pregnancy, particularly in high-risk obstetric settings. However, the potential for late renal recovery, even in severe cases, underscores the importance of persistent monitoring and supportive care.
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