Not an innocent bystander: case series of tranexamic acid induced cortical necrosis

Abstract

Acute cortical necrosis accounts for <2% of all acute kidney injuries. Pregnancy complications, viperine snake bites, haemolytic uremic syndrome, shock, and severe pancreatitis are all linked to it. There are relatively few case reports of acute cortical necrosis secondary to tranexamic acid, which is utilised in the treatment of acute bleeding because of its antifibrinolytic actions. Acute cortical necrosis is very infrequently brought on by medicines. Here, we present a group of three instances, each of which experienced the onset of oligo-anuria soon after receiving tranexamic acid. Cortical necrosis was demonstrated by contrast computed tomography (CT) and renal biopsy. While the third patient had patchy cortical necrosis and had partially recovered renal functions, the other two patients both had total acute cortical necrosis and are still reliant on dialysis. This case series demonstrates the need for clinicians to be cautious while using tranexamic acid and to be aware of the possibility of abrupt renal cortical necrosis following its administration.