Papillary and cortical necrosis of the kidneys in children. Kidney necrosis in children. Diagnosis and treatment of renal necrosis. Ayurveda and treatment of diseases⇒

Necrosis of the renal papillae (necrotizing papillitis or papillary necrosis)- destructive process, with predominant lesion renal papillae and leading to pronounced functional and morphological changes in it. The first report about him was made by N. Friedreich (1877) and long time this disease was considered rare. However, studies by Yu.A. Pytelya (1969) made it possible to establish that necrosis of the renal papillae occurs in 1% of patients with a urological profile and more than 3%, while women are 2 times more likely than men.

Yu.A. Pytel (1972) grouped all the causes leading to necrosis of the renal papillae as follows:

• changes in the vessels of the medulla with impaired blood flow in them;
• impaired blood supply to the renal papilla as a result of vascular compression due to edema, inflammatory and sclerotic changes both inside and outside the kidney;
• violations of the outflow of urine from the upper urinary tract with the occurrence of intrapelvic hypertension;
• purulent-inflammatory processes in medulla kidneys;
• endogenous and exogenous effects of toxins on the renal parenchyma;
• change in blood composition.

One of causes of development papillary necrosis the author considers a peculiar blood supply to the renal papilla. It is carried out due to direct false vessels extending from the efferent arteries of the juxtamedullary glomeruli and spiral arteries (from the interlobular and arcuate). With disorders in the circulatory system, ischemia develops in the region of the renal papilla, which is accompanied by the development of necrosis. This is also facilitated by the fact that the diameter of the vessels towards the top of the papilla decreases. This leads to an increase in blood viscosity in the vessels of the renal papilla.

Pelvic-renal refluxes also play a role in the development of necrosis of the renal papillae. Their development is promoted by pelvic hypertension. As a result, the sinus and interstitial tissue of the kidney is infiltrated, blood circulation in the kidney is disturbed, and renal ischemia develops.

The development of necrosis of the renal papillae may contribute to the obstruction of the urinary tract. In this case, urine accumulates in the pelvis, stretches it and compresses the renal tissue. This leads to compression of the kidney vessels. Ischemia sets in and favorable conditions for the development of infection. In addition, as a result of obstruction, urine enters the adipose tissue causes inflammation, sclerosis, venous congestion. All this aggravates ischemia of the renal parenchyma.

Yu.A. Pytel (1972) identifies primary necrosis of the renal papillae and secondary, developing against the background of previous pyelonephritis.

Symptoms and Diagnosis

The course of the disease can be acute and chronic.

Clinical symptoms of papillary necrosis varied but not specific. They are often characteristic of other diseases of the kidneys and upper urinary tract.

The most common symptoms of necrotic papillitis are,. These symptoms are not characteristic of this disease, but their presence makes one think of necrosis of the renal papillae. The difficulty of diagnosis is also due to the fact that necrotic papillitis is often combined with a disease such as pyelonephritis and, being either a cause or a complication of them. Therefore, the existence of pyelonephritis or nephrolithiasis does not yet exclude necrosis of the renal papillae. In some cases, the presence of a patient induces to look for necrosis in the medulla of the kidney, since this disease is most often complicated by necrosis of the renal papillae.

the only characteristic symptom for papillary necrosis is the excretion of necrotic masses in the urine. This symptom occurs in 10.2% of patients. The escaping masses are gray, of soft consistency, of a layered structure, and often contain lumps of lime salts. The presence of necrotic masses in the urine indicates a significant destructive process in the medulla of the kidney, both in nature and in volume.

There is a point of view that the diagnosis of necrosis of the renal papillae is impossible if the above pathognomonic sign is absent. However, this is not the case, since there are signs that make it possible to suspect the disease to a certain extent.

Often, necrotic papillitis occurs against the background of acute pyelonephritis, being its complication or cause. In this case, the symptoms of acute pyelonephritis come to the fore: stunning chills, heat aching or paroxysmal pain in lumbar region, headaches, malaise, severe weakness, hectic body temperature with chills and profuse sweat.

Hematuria is one of the most common symptoms papillary necrosis. It can be either an independent symptom or occur in combination with other symptoms and is most often of a total painless nature. In these cases, if a comprehensive examination does not allow to identify its cause, then dynamic monitoring of the patient, re-examination allows diagnosing necrosis of the renal papillae.

In the diagnosis of the disease, in addition to laboratory research, revealing signs of an inflammatory process (, leukocyturia,), X-ray methods of research are of great help. Sometimes on survey roentgenograms the necrotic triangular papilla encrusted with salts is visible. On excretory urography, it is possible to identify signs of acute pyelonephritis - atony of the calyces and pelvis, their deformation. However, in initial stage on excretory urograms, fornic and papillary destructions are hardly noticeable. Changes occur later in the period of rejection or significant destruction of the papilla. Because of this, if papillary necrosis is suspected, excretory urography should be repeated periodically. Retrograde pyelography undesirable as it easily leads to extravasation contrast medium with infected urine into the parenchyma by pelvic-renal reflux and, above all, tubular and sinus. But sometimes it also shows up.

AND I. Pytel, Yu.A. Pytel (1966) described the most characteristic radiological signs necrosis of the renal papillae:

• the shadow of a triangular calculus with a rarefaction zone in the center;
• small shadows of calcifications in the papillary-fornical zone of the calyces;
• blurred, as if corroded contours of the papilla and fornix;
• fuzzy contours tops of the papilla, erosion with an increase in its size, narrowing and lengthening of the arch;
• the formation of a fornic-medullary canal (fistula);
• an annular shadow around a sequestered papilla (symptom of "papillary loop");
• formation in the papilla of the canal (fistula);
• a cavity in the center of the renal pyramid, connected to the cup through a channel (fistula);
• torn papilla; the formation in its place of a recess with uneven contours in the distal part of the pyramid; the presence of a filling defect in the calyx or pelvis (usually triangular in shape); with occlusion of the pelvis or necrotic papilla, calico-pyeloectasia is observed;
• amputation of the cups due to edema, perifocal inflammation in the area of ​​their necks, or due to occlusion of a torn papilla; the contours of the cups are uneven, the papillae are deformed;
• leakage of a contrast agent into the renal parenchyma with total medullary necrosis (symptom of "bonfire flame");
• multiple defects in the filling of the pelvis and calyx, resembling a tumor of the pelvis or calculus.

AT last years In connection with the development of endoscopic techniques, it became possible to use examination of the renal pelvis, calyces, and, in some patients, the fornix zone, using rigid ureteropyeloscopes, in the diagnosis of necrosis of the renal papillae. This makes it possible to confirm the diagnosis, since it is possible to see the destruction of the papilla and hematuria from the fornix zone.

Unfortunately, others modern methods diagnostics - ultrasound, CT and MRI - are not very informative in the diagnosis of papillary necrosis. Much information can be obtained using these methods about comorbidities(nephrolithiasis and pyelonephritis).

Differential diagnosis is carried out with (, tubulomedullary dilatation, medullary hypoplasia, medulocalic dystopia and kidney dysplasia), pelvic-renal reflux, pyelonephritis.

Treatment

Treatment of patients with papillary necrosis should be pathogenetic. It is aimed at eliminating the cause (if it is established) that caused necrotic changes in the medulla of the kidney, as well as to combat urinary infection, hematuria, hyperthermia and intoxication.

If occlusion of the upper urinary tract occurs with necrotic masses, catheterization of the ureter and renal pelvis and the establishment of a stent are indicated.

If this manipulation does not bring an effect, then it is shown surgical treatment. Surgical treatment is also indicated for the development of acute pyelonephritis, which is not amenable to successful therapy in the next 2-3 days from the moment of occurrence. And, finally, the operation is indicated for profuse hematuria, which does not stop, despite the ongoing hemostatic therapy.

The operation should be as organ-preserving as possible. Remove necrotic masses, restore the outflow of urine by installing a stent. Necrotic masses can also be removed endoscopically. With profuse hematuria, the lesion is removed by resection of the kidney. In cases of total necrosis of the medulla and acute purulent pyelonephritis(with satisfactory function of the contralateral kidney), nephrectomy is possible. In the absence of indications for surgery, conservative treatment is carried out as in acute pyelonephritis using the entire arsenal of modern antibacterial agents.

The prognosis for timely treatment is favorable, since after the discharge of necrotic masses, epithelialization occurs wound surface and restoration of kidney function.

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 allergic reaction, violations of innervation and blood circulation. The severity of necrosis depends on general condition organism and unfavorable local factors.

The development of necrosis is facilitated by the presence pathogenic microorganisms, fungi, viruses. Also negative impact has cooling in the area where there is a violation of blood circulation, 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. There is pallor skin as a result of improper circulation, the skin color gradually becomes cyanotic, then black or dark green. If necrosis occurs in lower limbs, 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, necrotizing 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.

Types of necrosis

Depending on what changes occur in the tissues, two forms of necrosis are distinguished.

Children are cute creatures that quite often make us parents pretty worried. Special attention mothers and fathers devote to the general health of their beloved children. This is not surprising, since only healthy baby can be truly happy. Unfortunately, things don't always turn out well. These or other ailments quite often burst into the life of a child, and quite suddenly. Those children who day after day adhere to all the rules of a healthy lifestyle are no exception. site) will talk about diseases such as papillary and cortical necrosis kidneys in children. After reading the information provided, you can find out everything you need about the causes of development, symptoms, diagnosis, as well as methods of treating these ailments.

What is papillary necrosis of the kidneys in children?

In fact given state in most cases, it is a consequence of such ailments as diabetes mellitus, pyelonephritis, nephrolithiasis, hypertension and some others. Very rarely this disease makes itself felt as a primary kidney disease. This disease refers to a condition in which clear disorder blood circulation directly in the pyramids of the kidneys. Modern doctors experts distinguish two forms of this disease - these are unilateral and bilateral necrosis.

What is renal cortical necrosis?

What are the causes of papillary and cortical necrosis?

What is the clinical manifestation of papillary necrosis of the kidneys?

What are the symptoms of renal cortical necrosis in children?

How are these conditions diagnosed?

What are the treatments for these ailments?

A large number of people are affected by diseases of the urinary system. Almost every second person has cystitis or pyelonephritis. But these are far from the most formidable processes that can occur. The complications of these diseases are much more severe.

One of them is renal necrosis. This condition is characterized by normal structure cellular proteins, as a result of which the cells themselves begin to break down.

Why is this happening?

Most often, renal necrosis develops for the following reasons:

• bacteremia, or the entry of bacteria into the bloodstream due to common infectious processes;
• severe dehydration of the body, including with acute diarrhea;
• sublimate poisoning;
• injury;
• necrosis of the epithelium of the convoluted tubules of the kidney may develop in the presence of functional disorders in the work of the renal system;
• outflow disturbances urinary tract and infections Bladder;
• kidney injury.

AT separate group it is worth highlighting pregnant women. They have acute necrosis develops against the background of sudden detachment of the placenta or with anomalies of attachment.

What are the types of necrosis?

All necrosis of renal tissues are divided into 3 types:

1. prerenal insufficiency. In this form, there is a violation normal functioning due to changes in hemodynamics. Decreased blood flow leads to further development process.
2. Renal insufficiency. renal tubule damaged by ischemia. The functions of the organ will also be impaired.
3. Postrenal insufficiency. With this type of necrosis, the functional component is not disturbed. The destruction occurs due to damage to the walls of the bladder or ureters, as a result of which the outflow of urine is difficult.

What will be the manifestations?

Symptoms of kidney necrosis appear in the form. main feature is a change in the general condition of the patient in the worst side. The temperature rises, signs of intoxication of the body appear.

Further, the patient develops paroxysmal pain in the lumbar region, which cannot be relieved with conventional painkillers. The amount of urine excreted is reduced to 50 ml per day. AT clinical analysis urine, leukocytes are found in in large numbers, bacteria, and sometimes even blood.

Cortical vascular necrosis

How to be treated?

Treatment begins with the clarification of the underlying disease, which led to the development of necrosis. The doctor performs the necessary diagnostic tests, allowing to determine the nature of the pathogen and the degree of damage to the tubules.

Antibiotics are given first a wide range actions. After receiving the results of a urine test, it is possible to replace it with a narrower preparation.

If there has been damage to the ureters and bladder, then the causes that caused them are treated. In the presence of a stone, its destruction is performed. In more severe cases, catheterization of the renal pelvis is performed with the formation of a nephrostomy.

Acute process can be removed by hemodialysis. But this method of detoxification is best left to extreme case, since the clinic does not always have such a device, and excessive transportation of the patient to serious condition Not recommended.

In addition, the general condition of the body is corrected. The lost fluid is replenished, adaptogens and bed rest are prescribed.

From general recommendations you can also special treatment food and drink. Spicy and salty foods, smoked meats should be completely excluded from the diet. A diet low in salt and protein is prescribed. You need to drink at least 2 liters of fluid per day so that its amount does not decrease, as diuretics are used.

Kidney disease is very serious pathologies which can lead to a severe deterioration in the quality of life of the patient. All must be treated promptly. Bacteriocarrier is also not allowed, since with a decrease immune protection organism, for one reason or another, pathogens can become activated. Regular examinations and supervision by the attending physician will help prevent the development serious complications and keep healthy.

A condition in which there is a chaotic death cellular elements a paired organ of the urinary tract, 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.

Decreases as necrosis progresses functional activity paired organ and develops clinical picture general intoxication organism, which is caused by the accumulation of toxins and metabolic products in the systemic circulation. With untimely detection of necrotic changes in the kidneys, the 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, there are such varieties renal necrosis:

• 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 caused by ingestion of paired organ toxic and chemical compounds. Ischemic necrosis, as a rule, occurs in shock conditions, with sepsis, and also against the background of traumatic injuries. Tubular necrosis is characterized by 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 obturation (blockage) blood vessels feeding the paired organ. At insufficient blood supply violated functional state kidneys 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.

At acute form papillary necrosis, the patient is worried about acute pain syndrome, 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 insufficiency renal activity. Chronic form papillary necrosis is manifested by moderate pain in the lumbar region, leukocytosis in the urine, as well as signs of sickle cell anemia.

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

• Partial or complete absence 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, for short span time will result in death.

Diagnostics

For the correct formulation of the diagnosis, the doctor collects the patient's history and analyzes his complaints. Importance has a list of used medicinal medicines as well as diseases such as diabetes and heart failure.

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

Treatment

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

If the patient has been diagnosed papillary form necrosis, then he is prescribed a reception antispasmodic drugs and perform bladder catheterization. In addition, appointed antibacterial agents broad spectrum of action, drugs that improve blood circulation, as well as immunostimulants. With inefficiency conservative treatment, the issue of removing the damaged organ is being resolved.

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. Appointed infusion therapy course of antibiotic treatment, antiemetics and antispasmodics. 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. Save a person's life helps only timely diagnosis and proper treatment.

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