Papillary necrosis or necrotic papillitis: what is it, causes, symptoms, diagnosis, treatment

Very often as a complication of various diseases of the kidney tissue develops a pathological condition, which is called papillary necrosis.

Papillary necrosis - what is it?

Papillary necrosis( necrotizing papillitis) is a degenerative-destructive change in the structure of the renal papilla for some specific reasons. This disease affects the brain layer of the kidneys, causing changes in the functional abilities of urinary organs. Papillary necrosis is also called necrotic papillitis, as the process is caused by inflammation of the papillae.

Causes of

The most reliable cause of necrosis of the renal papillae is the ingestion of an E. coli in them, which provokes the development of the inflammatory process. Due to prolonged inflammation in the tissues, cell degeneration occurs, a scarring process is possible, which significantly affects the function of the organ.

There are several precisely-established causes and associated mechanisms for the development of necrotic kidney papillitis:

1. Increased urinary pressure in the renal pelvis. Pressure is increased due to excessive accumulation of urinary fluid in the cavity of the pelvis and disturbance of its outflow. The cause may serve as obstructive syndrome( swelling, ureteral stone).Also, a special role in the development of necrotic papillitis is played by the reverse casting of urine into the renal pelvis and calyx for some reason. Thus, the bacteria contained in the urine, fall on the kidney papillae and provoke inflammation.
2. Blood flow disorders in the medulla of the kidneys or abnormalities in the structure of the renal vessels. In the presence of atherosclerotic changes in the vessels or in the development of thrombosis, the flow of blood to the papillary apparatus of the kidney is disturbed, this condition is called ischemia. Later, the stage of ischemia is replaced by the necrotic stage.
3. Purulent processes in the kidney. The formation of purulent infiltrates or cavities filled with fluid can become one of the causes of disturbance of blood flow in the kidney and ischemia.
4. The pathology of blood, associated with a change in its qualitative composition and characteristics related to clotting.
5. Uncontrolled use of pain medication can lead to changes in the direct vessels that supply blood to the kidney papillae, and thereby cause necrosis.
6. Sickle cell anemia.

Necrotized renal papillae are rejected, they can cause urinary tract occlusion, can form coral-like stones over time.

Signs and symptoms

Necrotizing papillitis is classified according to clinical manifestations into two forms: acute and chronic.
Acute medullary necrosis is accompanied by high fever with chills, pain syndrome, characteristic of renal colic and urination with a significant admixture of blood( macrogemaria).If you do not provide medical care to the patient in time, severe renal failure develops rapidly.

The chronic form of necrotic papillitis is accompanied by painful syndromes( as in colic) that occur with a certain periodicity. In the urine, leukocyte cells and erythrocytes, protein tubular casts are found. Often patients with this pathology complain of urinary tract infections, which constantly recur.

Diagnostics

For the diagnosis of necrosis of the renal papilla, not only laboratory confirmation is needed, but also data from instrumental research methods. Quite informative are the methods of investigation using X-rays. On a survey radiograph, sclerosis of the medullary substance of the kidney can often be detected( it has the shape of a pyramid).When performing excretory or retrograde urography, it is possible to notice changes in the contours of the papillae themselves, the formation of ulcerative defects on them, the rejection of necrotic areas and calcifications. Sometimes the contrast material flows into the fistula formed, so you can study the extent of the spread of the destructive process in the kidney.

In this case, ultrasound diagnostics, scintigraphy and radioisotope methods of investigation are of little informative.

Treatment of

For effective therapy of papillary necrosis, the causative factors that caused the progression of the disease should be eliminated.

In the presence of purulent foci, therapy should be prescribed with antibacterial agents, with the formation of an abscess or other neoplasms that cause compression of the medulla of the kidneys-urgent surgical intervention( nephrostomy, excision of the kidney capsule and many other operations).Nephrectomy surgery is rarely used, since the process, in most cases, is two-sided.

Antiplatelet agents and anticoagulants are mandatory for improvement of blood rheology.

To prevent the development of medullary necrosis, you must carefully consider your health, especially those who suffer from diabetes mellitus, sickle cell anemia, systemic vasculitis. If you have any minor symptoms of impaired renal function, you should immediately visit a doctor and undergo a complete examination.