Renal Cortical Necrosis Etiology: Ischemia: Sepsis Shock Hemorrhage Burns Toxins: Aminoglycosides Heavy metals Mycotoxins Immunologic: Vasculitis Glomerulonephritis Obstructive: Bilateral ureteral obstruction Bilateral renal artery stenosis Pathophysiology: Ischemia leads to tubular cell injury and death. Tubular obstruction with debris and casts. Acute tubular necrosis (ATN) Renal cortical necrosis: If obstruction goes away: Tubules regenerate Renal function recovers If obstruction persists: Tubules remain damaged Renal cortical necrosis Clinical Features: Oliguria or anuria Elevated serum creatinine and BUN Metabolic acidosis Hyperkalemia Diagnosis: Renal ultrasound: Cortical thinning Loss of corticomedullary differentiation Renal biopsy: Tubular necrosis Interstitial inflammation Treatment & Management: Treat underlying cause Renal replacement therapy (RRT): Hemodialysis or peritoneal dialysis Supportive care: Fluid and electrolyte management Nutritional support Control of hypertension Prognosis: If severe, renal failure may be irreversible. Early recognition and treatment may improve outcomes.