Renal Cortical Necrosis Secondary to Idiopathic Acute Pancreatitis in a Young Adult: A Case Report

Renal cortical necrosis (RCN) is a rare and severe form of acute kidney injury (AKI), often resulting in irreversible kidney failure. We present the case of a 25-year-old male who developed severe acute pancreatitis (AP), leading to dialysis-requiring AKI. Despite remission of the initial AP episode, he remained anuric and dialysis-dependent for four weeks. A renal biopsy revealed diffuse cortical necrosis. He was continued on maintenance hemodialysis via a right internal jugular vein (IJV) tunneled venous catheter. Eight weeks after the initial episode, he presented with acute abdominal pain. Follow-up imaging studies showed gallbladder sludge and signs of walled-off pancreatic necrosis; endoscopic and surgical procedures (endoscopic ultrasound (EUS)-guided cystogastrostomy and laparoscopic cholecystectomy) were performed. However, he experienced repeated episodes of AP over the next 18 months. Genetic testing was negative, and the etiology was deemed idiopathic. Each episode was managed conservatively. He has been wait-listed for deceased donor renal transplantation and continues maintenance hemodialysis. Our patient developed dialysis-requiring AKI during the first episode of AP, secondary to RCN, and progressed to end-stage kidney disease (ESKD). He is currently awaiting renal transplantation. This case highlights the range of multi-organ dysfunction that can be associated with severe AP and its progression to chronic kidney disease.