Diffuse Cortical Necrosis of Native Kidneys in Sickle Cell Trait: A Case Report.

Abstract

Introduction: Sickle cell disorders are the most common hereditary hematological disorders; sickle cell trait (SCT) is largely benign with mild clinical manifestations, if any. Renal cortical necrosis (RCN) is a rare and severe form of kidney injury and, to our knowledge, has not been previously reported to affect the native kidneys of patients with SCT.

Case presentation: We describe a case of a 41-year-old male with a background of SCT who presented with acute abdominal pain and lower abdominal tenderness. He had rapidly rising creatinine over 48 h from 229 to 526 µmol/L, as well as elevated lactate dehydrogenase and total bilirubin at 2,606 U/L and 31 µmol/L, respectively. His toxicology, viral, and autoimmune profiles were negative, with a normal kidney ultrasound scan. The kidney biopsy revealed diffuse RCN. The patient was managed conservatively and had partial recovery of his kidney function to a baseline creatinine of 176 µmol/L 6 months later.

Conclusion: Although SCT has long been considered a benign condition, growing evidence suggests that vaso-occlusive manifestations can occur, especially in the context of physiological stressors. This is the first described case of diffuse RCN affecting the native kidneys of a patient with SCT without an identifiable stressor, highlighting the need for vigilance in managing SCT and its potential severe kidney manifestations.