Until recently, the kidney infarction was considered a very rare disease: the very concept of "ischemic kidney disease" began to be actively used in medicine only in the 50s of the last century. Today, problems with renal blood supply occur in patients of mature and elderly age more often. This is due to the addiction to alcohol, cigarettes, drug use and the rapidly deteriorating environmental situation in different parts of the world.
Kidney infarction - description of
We are used to the fact that the word "infarct" is always adjacent to the term "myocardium" - the heart muscle. Therefore, when speaking about a heart attack in a person, most often they mean exactly the problems with the heart. In fact, this phenomenon can occur with every organ that has a developed circulatory system.
Kidney infarction is the dying off( in medicine - necrosis) of tissues, which occurs due to a sharp stop of blood flow in the renal vein or artery. And in rare cases - in several vessels at the same time.
When the renal infarction does not suffer the whole body - only a small area dies. But for this to happen, a complete stop of blood circulation is necessary because of the occlusion of the vessels, that is, the sharply occluded obstruction. If the blood flow remains a little or vascular obstruction gradually increases, other kidney pathologies arise. This is hypertension, renal failure of various forms, etc.
Forms of
The circulatory system of the kidneys includes two arteries( right and left, according to the number of organs themselves), two veins that practically repeat the movement of the arteries, and many smaller vessels. In any of these vessels, a thrombus can appear, which will stop the movement of blood. In addition, to provoke a heart attack are capable of crystals of urate accumulated in the kidneys.
Depending on the problem that caused the development of a heart attack, three forms of the disease are distinguished:
- Ischemic( arterial, or "white").
- Hemorrhagic( venous, or "red").
- Urine.
In vascular forms, a vein or artery occludes, which causes the blood supply to the organ to be impaired and tissue death begins. In this case, a comprehensive diagnosis( including differential diagnosis) and serious treatment is necessary. Such a kidney infarction is usually diagnosed in elderly or mature people, mainly on the background of cardiovascular diseases.
A uric acid infarct is usually found in a newborn. Medical statistics say that half of the kids get a uric acid infarct of the kidney on the 2-5th birthday. Much less often this pathology is diagnosed in adults with gout, leukemia, tumors of various types and purulent diseases of tissues.
Causes of
The only cause of arterial and venous infarction of the kidney is a sudden blockage of the vessel, because of which there is a stoppage of blood circulation.
Occlusion of the vessel can occur due to embolism( clogging with a thrombus that has passed with blood flow from other vessels) or thrombosis( when a thrombus forms directly inside the renal artery or vein).
Thromboembolism of renal vessels is a consequence of cardiovascular ailments. As a trigger for a kidney infarction, a parietal thrombus of the left atrium or ventricle usually appears here.
Therefore, myocardial infarction of the left or right kidney traditionally occurs against the background of the following diseases:
- heart defects;Atrial fibrillation;
- infective endocarditis;
- atherosclerosis;
- hypertension;
- myocardial infarction, etc.
Thrombosis of the renal artery( less often - the veins) occurs when the vascular wall is damaged. The reasons can be various: atherosclerosis in the severe stage, aortoarteritis( inflammation of the vascular walls), connective tissue diseases, sickle cell disease, when the composition of the blood changes.
In some cases, the cause of thrombosis is surgical intervention, most often angiography( X-ray of blood vessels).The wicked irony is that angiography is often used for differential diagnosis of a kidney infarct - and at the same time can provoke its real development.
Stages of
A feature of the kidney infarction in the very rapid development of the disease. The death of a tissue site in the kidney is possible only in one case - if the blood flow in the artery or vein stops abruptly and completely. Therefore, medical science does not name clear and consistent stages of the development of the disease.
But, like any other infarction, kidney damage has certain regularities. First, there arises a peculiar pre-infarction state - ischemia. Blood flow at this time slows down, cell respiration worsens, toxins accumulate in the tissues.
After 6 hours, the epithelial cells of the convoluted tubules of the kidneys begin to die, and after a few hours - the straight tubules. At the same time, the inflammatory process develops, which peaks on the third day of the infarction.
Clinical picture of
Kidney infarction does not have any characteristic symptoms, and in some cases can generally occur without obvious signs. This usually occurs if the area of necrosis is small.
When the lesion covers a significant area of the kidney, the patient develops a severe malaise:
- pain in the lower back, kidneys, upper abdomen;
- chills and fever up to 38ºC;
- increased pressure;
- nausea and vomiting;
- muscle tension of the anterior abdominal wall, pain during palpation;
- admixture of blood in the urine;
- brick-red and at the same time murky color of urine( with the form of urea);
- at the most severe stage - complete cessation of urination.
Arterial and venous heart attacks have different symptoms.
Venous tissue damage begins more smoothly, it is preceded by a prodromal period, when the patient has a fever, heart palpitations, he becomes restless. Soon there are severe pains, blood clots in the urine always appear( sometimes there are so many of them that this interferes with the normal outflow of urine).The kidney increases in size, with a palpation patient experiences painful pain.
Explicit differences in venous and arterial infarction shows the micro-preparation of the kidney - a special section( cut) of the tissue for examination. If the infarct is ischemic, the micropreparation looks like a small white triangle with a red rim( this is a hemorrhage).With hemorrhagic form, the micropreparation has a distinct form, a dark red color and almost black edges.
Diagnostics
Since it is impossible to uniquely identify the infarct of the kidney by symptoms, the diagnosis is the most thorough. It includes a complete history, laboratory methods and instrumental.
Anamnesis history should include complete information about the patient's illnesses( especially cardiovascular), the drugs that he is taking, the state of health and any suspicious symptoms lately.
Laboratory methods include:
- general urine analysis( a dangerous sign - proteinuria and hematuria);
- general blood test( moderate leukocytosis);
- biochemical analysis of blood and urine( concentration of C-reactive protein urovenenlactate dehydrogenase);
- coagulogram - a study of blood clotting.
Among the instrumental methods of basic-renal imaging with dopplerography( the study of blood flow velocity).Less commonly used are computed tomography, MRI, and angiography.
Treatment
At the slightest suspicion of a kidney infarction, the patient needs urgent hospitalization. Already in the hospital, the doctor prescribes appropriate treatment, which includes 2 large units: conservative( medications) and surgical.
Conservative
Immediately after admission to a patient with a diagnosed infarction, the kidneys are assigned the following groups of drugs:
- powerful painkillers( Fentanyl, Omnolon, etc.);
- sodium etamzilate( for stopping bleeding);
- thrombolytics( if a little time has passed and the blood does not penetrate into the urine);
- anticoagulants to prevent the development of thrombi( heparin sodium, etc.).
After treatment, antiplatelet agents are prescribed - substances that prevent the platelets from clumping( acetylsalicylic acid, etc.).Admission requires a long, often - a lifetime.
Surgical
In the early stages of a heart attack, when a little time has passed since the vein or artery has been blocked, surgical removal of the thrombus( embolus) helps to save the patient. If necessary, also carry out balloon angioplasty.
A uric acid infarct in newborn babies does not require treatment. This state is considered natural, physiological, and passes by itself. The only "curative" measure is to solder the baby with water along with breastfeeding. Urine will be allocated more intensively, and the infarcted masses( salt formations) will wash out with it.
Forecasts and complications of
Forecasts for infarction of the kidney are usually favorable. If the disease was found at an early stage, then after surgery, a small scar is formed on the site of necrosis, and the surrounding tissues take on the function of the dead region.
If the patient has a risk of thrombosis, it is also possible to lead a full life after the operation. But in this case, you have to adjust your diet, nutrition, constantly take medications and regularly undergo a complete examination. The same is true for patients with a remote "infarct" kidney.
The main consequence of a kidney infarction is a nephrosclerosis( replacement of a dead kidney tissue with a connective one).If a large volume of living kidneys is lost, there is a risk of developing hypertension and chronic kidney failure.
On video, symptoms, description, treatment of a kidney infarction: