Kidney necrosis in children. Diagnosis and treatment of renal necrosis. Necrosis of kidney tissue Death of the kidney symptoms

Necrosis of the kidney is a disease accompanied by a violation, the separation of cytoplasmic proteins. As a result, a characteristic process of cell destruction occurs. This disease is often observed in violation of the blood supply, as well as due to exposure to pathogens - bacteria or viruses.

What types of kidney necrosis are, symptoms, treatment, causes of this disease, what are they? Let's talk about it today:

Classification of necrosis

There are the following types of this pathology:

prerenal insufficiency: this type of necrosis is characterized by a pronounced violation of the functionality of the organ, due to a general violation of hemodynamics. This variety often transforms into renal insufficiency, since impaired renal blood flow is the main cause of ischemia.

Renal insufficiency: With this type, the functionality of the kidney is impaired due to damage to the tissue of the organ. Usually, renal insufficiency occurs after warm ischemia or cold ischemia.

Postrenal Deficiency: In this variety, the functionality of the kidneys is usually not affected. Difficulty, lack of excretion of urine occurs due to damage to the urinary tract. This variety can be converted to renal when the renal pelvis overflowing with urine compresses the tissues of the kidney, which contributes to the occurrence of ischemia.

Why does kidney necrosis occur? Causes of the condition

In children, infants, this disease can occur due to the penetration of bacteria into the blood, as well as due to dehydration (dehydration), or due to hemolytic-uremic syndrome (acute diarrhea). Kidney necrosis in adults is often caused by bacterial sepsis.

In pregnant women, pathology can develop due to the sudden separation of the placenta, or due to its incorrect location. In addition, this pathology is diagnosed with severe uterine bleeding, when the artery is filled with amniotic fluid, etc.

Other reasons include: rejection of a transplanted kidney that has not taken root, kidney injury, and inflammatory diseases of the pancreas. To provoke a pathological process can be a bite of a poisonous snake, as well as arsenic poisoning.

Necrotic papillitis or necrosis of the renal tubules often develops due to organic or functional disorders, which are characterized by destructive processes, changes in the medulla of the kidney.

Diseases such as diabetes mellitus, prolonged vasospasm, as well as thrombosis, atherosclerosis, anemia, urinary infection, etc. can provoke necrosis. There is a high risk of developing acute tubular necrosis in patients who have suffered severe renal injuries, as well as in those who have undergone surgery dissecting aortic aneurysm.

How does renal necrosis manifest itself? Symptoms of the disease

The main sign of developing necrosis is a deterioration in the general condition that occurs against the background of the underlying disease. Patients complain of severe lumbar pain, severe hyperthermia. There is high oliguria and other manifestations of acute renal failure. In this case, there are signs of serious leukocyturia, bacteriuria, hematuria. Sometimes pieces of renal papillae are found in the urine.

With timely access to a doctor, with timely treatment, the patient recovers completely. Otherwise, the disease can go to a recurrent course with severe attacks of renal colic. A severe course without the necessary, timely treatment can be fatal.

How is kidney necrosis corrected? Treatment of the condition

The main thing in the treatment of this disease is the diagnosis, elimination of the underlying pathology that caused necrosis. Carry out therapeutic measures aimed at improving, resuming blood microcirculation, eliminating bacteriuria, treating dehydration and arterial hypertension.

In the presence of complications, which often arise due to ureteral resistance in massive hematuria, the patient is subject to emergency hospitalization.

In order to restore, normalize the passage of urine, the patient is shown catheterization of the renal pelvis with the imposition of a nephrostomy. Medical treatment consists of taking antibiotics. In acute renal failure, the patient undergoes hemodialysis. Patients with polyuria are advised to drink more, not to limit salt intake.

Necrosis of the kidney, signs, therapy, the causes of which we have discussed with you today is a pathology with very serious negative consequences. To prevent or reduce the risk of developing necrosis, diseases that can cause it should be treated in a timely manner. Be healthy!

Causes of necrosis

Necrosis is the irreversible cessation of the vital activity of cells, tissues or organs in a living organism, caused by the influence of pathogenic microbes. The cause of necrosis may be tissue destruction by a mechanical, thermal, chemical, infectious-toxic agent. This phenomenon occurs due to an allergic reaction, impaired innervation and blood circulation. The severity of necrosis depends on the general condition of the body and adverse local factors.

The development of necrosis is facilitated by the presence of pathogenic microorganisms, fungi, viruses. Also, cooling in the area where there is a violation of blood circulation has a negative effect, in such conditions, vasospasm increases and blood circulation is even more disturbed. Excessive overheating affects the increase in metabolism and with a lack of blood circulation, necrotic processes appear.

Symptoms of necrosis

Numbness, lack of sensitivity is the very first symptom that should be the reason for visiting a doctor. Paleness of the skin is observed as a result of improper blood circulation, gradually the skin color becomes cyanotic, then black or dark green. If necrosis occurs in the lower extremities, then at first it is manifested by rapid fatigue when walking, a feeling of cold, the appearance of lameness, after which non-healing trophic ulcers are formed that necrotic over time.

The deterioration of the general condition of the body occurs from violations of the functions of the central nervous system, blood circulation, respiratory system, kidneys, liver. At the same time, there is a decrease in immunity due to the appearance of concomitant blood diseases and. There is a metabolic disorder, exhaustion, hypovitaminosis and overwork.

Necrosis of the kidney is diagnosed with destructive processes in the tissues of the organ, which are manifested by swelling of protein molecules. Kidney destruction develops as a pathological complication of many diseases or as a result of intoxication of the body. This disease is dangerous because it can initiate kidney failure.

The kidney is a paired bean-shaped organ whose main task is to form urine and protect blood from intoxication by filtering it.

Additional functions of the kidneys are:

excretion of toxins and drugs in the urine;
regulation of electrolytes in the bloodstream;
control of acid-base balance;
support healthy blood pressure levels;
production of biologically active substances.

The right kidney is smaller than the left, and it is more prone to various pathologies. The adrenal glands are located in the upper region of the body, their task is hormonal synthesis. The hormones produced control the metabolic processes in the body, affect the functioning of the circulatory system, internal organs, and the skeleton.

Violation of renal functioning affects the general well-being of a person. One of the dangerous pathologies is necrosis. Atherosclerosis, thrombosis, diabetes mellitus, and analgesics contribute to the onset of the disease.

Characteristics of the pathology

With necrosis of the kidneys, damage to the proteins of the cytoplasm is fixed, in which the cellular structure of the organ dies. The disease is diagnosed in people of different ages, including newborns.

The main causes of the disease include:

infectious processes, sepsis;
trauma, blood loss;
placental passage during pregnancy;
kidney rejection after transplantation;
intoxication with chemical compounds;
exacerbation of cardiovascular pathologies.

Depending on the localization of the lesion, there are cortical, tubular, papillary types of the disease.

Cortical

A rarely diagnosed type of necrosis, in which the outer renal membrane is affected, while the inner remains intact. The cause of the pathology is the blockage of small vessels that feed the cortical layer.

Kidney disease is manifested by the following symptoms:

reduction or absence of urination;
blood in the urine;
heat.

In addition, changes in blood pressure values, as well as pulmonary edema, are possible.

Important! Endotoxic shock contributes to the centralization of blood flow, its deficiency, which causes necrosis of the tissues of the organ.

The cortical appearance is often found in infants. This is due to placental abruption, blood poisoning, infectious processes. In women, in most cases, the disease manifests itself in the postpartum period due to uterine bleeding, infectious diseases, and compression of the arteries.

Papillary

Papillary necrosis is the death of the renal papilla. The functionality of the organ is impaired due to the destruction of the brain area.

By the way! In patients suffering from pyelonephritis, papillary necrosis is diagnosed in 3% of cases.

The acute form of the disease is manifested by colic, chills, cessation of urination.

The causes of pathology are:

dysfunction of the blood supply to the brain and renal papillae;
violation of the outflow of urine in the pelvis;
inflammatory phenomena, purulent formations in the organ;
toxic poisoning of the tissue structure of the kidney.

The disease is more common in women.

tubular

Tubular necrosis of the kidneys (acute tubular) is characterized by damage to the mucous membrane of the tubules of nephrons, which provokes renal failure.

Acute tubular necrosis occurs in two forms:

Ischemic. Pathology is caused by mechanical damage, sepsis, "oxygen starvation" of the blood, inflammation.
Nephrotoxic. It becomes a consequence of severe intoxication of the body.

Acute tubular necrosis develops as a result of serious damage to the epithelium of the tubules, accompanied by intense tissue inflammation. As a result, the renal structure changes, initiating organ failure.

Methods of diagnosis and treatment

The collection of anamnesis plays a predominant role in the diagnosis. Samples are taken, ultrasound scans and X-rays are taken. A CT scan may be needed. Each type of disease is differentiated in different ways.

The main therapeutic task is to eliminate inflammatory foci and prevent the death of the renal structure and tubules. The treatment regimen for necrosis depends on the type of disease and the factors that provoked the disease.

Therapeutic measures:

When a papillary species is detected, antispasmodics are prescribed. In case of obstruction of the ureter, a catheter must be inserted. Medicines are used that restore blood supply, increase the immune status, and antibiotics. In the absence of positive dynamics from drug therapy, it is necessary to remove the affected organ.
Acute tubular necrosis is treated with antibacterial drugs that regulate blood circulation in the kidney. The body is cleansed of toxic elements.
With a cortical form of pathology, treatment is aimed at restoring blood flow in the brain section of the organ. Infections are eliminated with antibiotics.

With untimely therapy, renal failure develops, which is accompanied by intense poisoning of the body with damage to other organs.

The operation is prescribed only in advanced cases, when the destruction affects the entire structure of the kidney. In case of thrombosis of the vessel, thrombectomy is performed.

In the case of diagnosing the disease at the initial stage, the work of the kidney can be restored. However, many patients are shown a regular procedure of dialysis (blood cleansing) or organ transplantation. Recovery is based on the elimination of a bacterial infection and on improving the reactivity of the human body.

Renal necrosis is a serious disease leading to death if left untreated. To prevent irreparable consequences, undergo regular examinations. If you experience strange symptoms, contact your doctor immediately.

Every person suffering from at least some chronic pathology should be aware of the first signs of death of kidney tissue, which is called renal necrosis.

kidney necrosis

Necrosis of the kidneys is the process of necrosis of the cells of the kidney tissue. As a result of the research, it was found that kidney necrosis is characterized by swelling of cells and protein structures in them, followed by destruction (lysis).

Necrotic changes in the kidneys can occur due to severe intoxication with any poisonous substances, as a result of the development of autoimmune processes in the human body. Quite often, the cause of the destruction of kidney cells is a decrease in blood flow in the organ itself. With a decrease in the degree of blood supply, ischemia and hypoxia of the cellular system of the kidney develops, and then the destruction of cells.

Violation of blood flow to the kidney may occur due to thrombosis of the renal vessels or obstruction of the urinary tract by a stone or neoplasm.

Often, kidney necrosis develops in pregnant women and parturient women, this is due to heavy bleeding from the uterine cavity or premature detachment of a normal or pathologically placed placenta.

In children, this pathology occurs against the background of a viral or bacterial disease as a complication of dehydration (with profuse vomiting or diarrhea).

Kinds

Necrosis of epithelial cells of convoluted tubules

Toxic substances affect the most sensitive areas of the kidneys - the epithelium of the tubular apparatus.

The role of toxic substances can be:

Pesticides that are part of various toxic substances or detergents;
Heavy metal compounds, often mercury, lead and arsenic;
Ethylene glycol is a representative of organic solvents.

In the photo, necrotic changes in the epithelial cells of the convoluted tubules of the kidneys or acute tubular necrosis - micropreparation

A. - Non-nuclear cells; B. - Preserved nuclei in the cells of the loop of Henle; B. The vessels are filled with blood and dilated.
Also, a possible cause of acute tubular necrosis can be an injury, which consists in strong squeezing of the organ, as a result of which blood flow to the tubules of the kidneys is disturbed.

In case of blockage of the ureter due to a violation of the outflow of urine, the tubules expand, their epithelium becomes necrotic and desquamated.

This type of necrosis manifests itself with acute or gradual urinary retention, blood initially appears in the urine, and the frequency of urination per day decreases. Very often, patients feel discomfort and sharp pain in the lumbar region. The patient may have a fever. Such symptoms occur due to the development of a dangerous pathological condition with kidney dysfunction - renal failure.

Acute tubular necrosis of the kidneys - macropreparation

cortical

Necrosis of the cortical substance of the kidneys (cortical) is more common in newborns or in pregnant women.

Pathogenetically, necrosis of the cortex is due to increased intravascular coagulation locally in the kidneys or totally (in the bloodstream of the whole organism). The blood coagulates intensively due to a decrease in the level of fibrinogen and an increase in the concentration of thromboplastin and thrombin. There is a blockage of the blood-carrying (afferent) renal arterioles, which leads to disruption of the blood supply and shrinkage of the kidney.

As a result of criminal abortion under inappropriate conditions, bacteria enter the bloodstream and release toxins. A sharp intake of such toxins in large quantities into the blood provokes the development of a shock state (endotoxic shock).

In shock conditions, the blood flow becomes centralized, blood does not enter the cortical layer of the kidneys in a normal amount, and necrosis occurs.

Quite often, necrotic changes in the cortical layer end with the deposition of calcifications.

Symptoms for this type of pathology can be varied: there is urination with blood, the frequency of urination decreases until it is completely absent. There may be pain in the back (lower part), in the abdomen, vomiting and severe nausea, fever. If the process of intravascular coagulation is total, symptoms of damage to other organs join. Hemorrhages appear on the skin.

Cortical necrosis of the kidney

Papillary

The main etiological factor in the development of necrotic changes in the cells of the papillae of the kidneys is a bacterial infection. Bacteria can enter the pelvis from outside through the urinary tract, and are also transferred to the kidney with blood (hematogenous route). With an increase in urine pressure in the pelvis, bacteria spread to one or more papillae. As a result, cell lysis develops, blood flow to the kidney pyramids is disturbed.

The symptomatology is represented by a pronounced febrile state, pain syndrome, pronounced intoxication signs.

Papillary necrosis of the kidneys

Cheesy

Necrosis of the renal tissue of the caseous type usually develops at the site of growth and development of tuberculous or syphilitic granulomas (growths). Often the cause of this pathology can be a disease such as leprosy. Caseous areas resemble curdled mass on examination. Under the microscope, the homogeneous nature of the kidney tissue, destroyed cells and connective tissue fibers are noted.

Diagnosis of tuberculosis and syphilis by initial clinical manifestations is quite difficult. There may be periods of a significant rise in body temperature, for a long time leukocytes and erythrocytes can be detected in the urine in large quantities.

The diagnosis can be confirmed by laboratory and instrumental studies. The most informative diagnostic method is considered to be a puncture biopsy of the kidney.

Caseous nephrosis

Focal

Focal necrosis of the renal tissue is usually caused by bacterial flora (syphilis, tuberculosis, leprosy and some other diseases). Symptoms are similar to those in the above forms of kidney necrosis.

Treatment

The main principles of the treatment of kidney necrosis are to eliminate the root cause of the pathological process. For this, it is necessary to carry out a complete clinical and laboratory examination.

Therapeutic measures depending on the etiology and pathogenetic mechanisms of the development of the disease:

Antibacterial therapy;
Improvement of hemodynamics (anticoagulant therapy);
Elimination of obstructive urinary tract syndrome (possible and formation of a nephrostomy).
Elimination of signs of renal failure and elimination of toxic substances (using hemodialysis);
To relieve pain, antispasmodics or non-narcotic / narcotic analgesics are prescribed.

Surgical interventions are carried out only in severe cases of the development of the disease. If necrosis covers almost the entire area of \u200b\u200bthe kidney, then it is completely removed ().

If the cause of necrosis is vascular thrombosis, then thrombectomy and angioplasty with a balloon are widely used.

The prognosis for early detection of signs of ischemia of the renal tissue is quite favorable. Areas of necrosis as a result of timely and proper treatment are compacted and turn into a scar. And the surrounding active kidney cells compensate for their work.

Attention! In order to prevent necrosis of the renal tissue, it is recommended to be attentive to your health, to control the state of the cardiovascular, endocrine, and genitourinary systems. And when the slightest alarming symptoms appear, you should immediately consult a doctor!

The condition in which the chaotic death of the cellular elements of the paired organ of the urinary tract is observed is called kidney necrosis. This severe structural and functional pathology is characterized by the rate of progression and the development of irreversible changes leading to renal failure.

As necrosis develops, the functional activity of the paired organ decreases and a clinical picture of general intoxication of the body develops, which is caused by the accumulation of toxins and metabolic products in the systemic circulation. With untimely detection of necrotic changes in the kidneys, a person's condition will rapidly deteriorate and lead to death.

If we talk in detail about what kidney necrosis is, then this condition can be characterized as structural damage to the proteins of the cytoplasm of the cells of the paired organ, resulting in the death of individual sections of the kidney tissue.

This condition occurs with the same frequency in both adult patients and newborns. Potential factors in the development of necrotic changes include:

Generalized spread of infection throughout the body (sepsis);
Traumatic damage to the kidney area;
Rejection by the body of a previously transplanted kidney;
Placental abruption in a pregnant woman;
Bites of poisonous snakes and insects;
Poisoning with toxic components and chemical compounds;
Complications of already existing diseases of the vessels and heart.

Classification

Depending on the localization of necrotic changes and the processes occurring in the paired organ, the following types of renal necrosis are distinguished:

Tubular (acute) necrosis. In this case, necrotic changes affect the epithelium of the renal tubules. The disease itself is divided into nephrotoxic and ischemic necrosis. Nephrotoxic necrosis is provoked by the ingress of toxic and chemical compounds into the paired organ. Ischemic necrosis, as a rule, occurs in shock conditions, with sepsis, as well as against the background of traumatic injuries. Tubular necrosis is characterized by an intense inflammatory process, under the influence of which the tissue of the paired organ is damaged, its structure changes and insufficiency is formed.
Cortical necrosis or sublimate kidney. This pathology occurs with partial or complete obstruction (blockage) of the blood vessels that feed the paired organ. With insufficient blood supply, the functional state of the kidney is disturbed and its insufficiency is formed. In no less than 35% of cases of diagnosed cortical necrosis, the pathology arose against the background of a septic lesion of the body. In addition to sepsis, intoxication with chemical compounds, burns, transplantation procedures and injuries can provoke the disease. In newborns, cortical renal necrosis occurs if a pregnant woman has encountered the problem of placental abruption.
Papillonekrosis. The papillary form of this disease is characterized by involvement in the necrotic process of the medulla of the kidney and renal papillae. At least 3% of people who have previously had pyelonephritis experience complications in the form of papillary necrosis. Female patients are 2 times more likely to experience this disease.

Symptoms

Clinical manifestations of renal necrosis directly depend on the form of the disease.

In the acute form of papillary necrosis, the patient is worried about acute pain, severe chills and fever. In addition, when emptying the bladder, blood fragments are visible in the urine. If the patient is not provided timely assistance, then within 3-5 days he will develop acute renal failure. The chronic form of papillary necrosis is manifested by moderate pain in the lumbar region, leukocytosis in the urine, and signs of sickle cell anemia.

When forming a sublimate kidney, the following clinical symptoms come to the fore:

Partial or complete absence of the act of emptying the bladder;
Pain in the projection of the kidneys;
The appearance of blood fragments in urine, as a result of which it acquires the characteristic color of urine in renal necrosis: brown or red;
Decreased blood pressure;
An increase in body temperature.

For the tubular form of renal necrosis, the following clinical manifestations are characteristic:

Edema in the face, neck and lower extremities;
Drowsiness;
Nausea and vomiting;
Decrease in the volume of urine excreted;
Severe damage to the central nervous system, which manifests itself in the form of confusion, up to coma.

It is important to remember that untimely assistance to a person with signs of one or another type of renal necrosis will lead to death in a short period of time.

Diagnostics

For the correct formulation of the diagnosis, the doctor collects the patient's history and analyzes his complaints. The list of medications used, as well as the presence of diseases such as diabetes mellitus and heart failure, is important.

It is also important to take into account information about possible contact with poisonous, toxic and other chemical compounds. The following options for laboratory and instrumental examination will help confirm the clinical diagnosis:

Treatment

The primary task in diagnosing renal necrosis is to eliminate the cause that provoked this severe complication.

If the patient has been diagnosed with a papillary form of necrosis, then he is prescribed antispasmodic drugs and bladder catheterization is performed. In addition, broad-spectrum antibacterial agents, drugs that improve blood circulation, as well as immunostimulants are prescribed. With the ineffectiveness of conservative treatment, the issue of removing the damaged organ is decided.

With the development of necrotic changes in the area of the cortex of the paired organ, measures are taken to restore the normal blood supply to the kidney, the blood is cleansed of toxic elements using the hemodialysis procedure, and a course of antibiotic therapy is prescribed.

If necrosis has touched the tubules of the kidneys, a set of measures is being implemented to eliminate the general intoxication of the body. Infusion therapy, a course of antibiotic treatment, antiemetics and antispasmodics are prescribed. In severe cases, patients undergo hemodialysis.

Complications and prognosis

A single variant of complications for each form of renal necrosis is functional insufficiency of renal activity. This condition is characterized by severe intoxication of the whole organism, heart failure and septic complications. Only timely diagnosis and proper treatment can save a person's life.

With timely treatment, it is possible to preserve the paired organ and restore its functional state. Despite this, statistics indicate that 70% of patients with a similar problem need an organ transplant. For patients with diagnosed necrosis, hemodialysis is vital. In especially severe cases, with untimely treatment, a fatal outcome is likely.