Disseminated intravascular coagulation (DIC) refers to diffuse, uncontrolled clotting within blood vessels, and formation of thrombosis. Renal cortical necrosis refers to the death of areas of tissue surrounded by healthy parts, which, in this case, is the outer layer of the kidney.

Etiologic factors related to renal cortical necrosis and disseminated intravascular coagulation are as follows:

• Renal cortical necrosis - The condition may occur at any age. It may be caused by conditions including: DIC; complications of pregnancy; bacterial sepsis; hemolytic-uremic syndrome; kidney transplant rejection; burns; pancreatitis; trauma; snakebites; and poisoning. Other factors contributing to this condition include: vasospasms; activated clotting mechanisms; injury to the immune system; endotoxins; septic shock; and direct cell injury.

• Disseminated intravascular coagulation - In addition to the causes related to renal cortical necrosis, disseminated intravascular coagulation may be caused by: intravascular hemolysis, such as incompatible blood transfusions; viral, rickettsial, and protozoal infections; surgical procedures; heatstroke; severe head injury; malignancies; liver disease; fat embolism; cardiac arrest; giant hemangioma; severe venous thrombosis; purpura fulminans; and systemic lupus erythematosus (SLE).

Manifestations related to renal cortical necrosis and disseminated intravascular coagulation are as follows:

• Renal cortical necrosis - Symptoms may include: oliguria; anuria; hematuria; flank pain; kidney enlargement; fever; and abnormal laboratory and urine studies. In addition, there may be hypertension or hypotension, and calcifications in the kidney may appear after several weeks.

• Disseminated intravascular coagulation - Symptoms may include: hemorrhage; bleeding from a surgical site; bleeding gums; nosebleed; petechiae; ecchymosis; hematomas; signs of acute tubular necrosis; nausea and vomiting; muscle, back or abdominal pain; bleeding from the gastrointestinal (GI) tract; hemoptysis; chest pain; dyspnea; and seizures. Changes in mental status and coma may also occur.

Diagnostic measures for the condition include: urinalysis and urine culture studies; blood and chemistry studies; and cultures of tissue. In addition, other tests may include: x-ray; intravenous urography (IVU); pyelography examinations; ultrasonography; magnetic resonance imaging (MRI); computed tomography (CT) scan; and renal biopsy.

Measures of treatment for renal cortical necrosis and disseminated intravascular coagulation are as follows:

• Renal cortical necrosis - The treatment may be directed toward correcting the underlying disease, and may include hemodialysis or kidney transplantation.

• Disseminated intravascular coagulation - The treatment may depend on early detection and severity of hemorrhage, as well as treatment of the underlying disease. Measures used may include: frequent rest periods; anticoagulants; pain medication; oxygen therapy; topical hemostatic agents; fibrinolytic inhibitors; and blood transfusions. Monitoring of the neurologic status, intake and output, daily bodyweight, and serial blood and urine samples may also be needed. In addition, there may be a need to limit venipuncture sites, to omit parenteral injections, and to protect the patient from injury.

Some kidney function may be regained. Accelerated or malignant hypertension may occur. In the event of a kidney transplant, rejection is a lifelong major concern that requires antirejection medications for life. Disseminated intravascular coagulation may be chronic in cancer patients. There may be a need for counseling.

• This disease, (condition), only in its active form , has a 3 year presumptive period and shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied. [38 CFR 3.309 [Disease subject to presumptive service connection], 38 CFR 3.309(a). [chronic disease].

• May be entitled to special monthly compensation where the veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• The new criteria for the Genitourinary Disease and Conditions body system became effective November 14, 2021.  Review both current and historic criteria prior to any reduction for disabilities established before that date.  38 CFR 3.951(a)

• When evaluating any claim involving loss or loss of use of one or more creative organs, refer to 38 CFR 3.350 of this chapter to determine whether the Veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, there are other conditions in this section which under certain circumstances also establish entitlement to special monthly compensation.

• GFR, estimated GFR (eGFR), and creatinine-based approximations of GFR will be accepted for evaluation purposes when determined to be appropriate and calculated by a medical professional.