Renal papillary necrosis. Symptoms and treatment of kidney necrosis. Symptoms and treatment of kidney adenoma

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 can develop in the presence of functional disorders in the work of the renal system;
urinary tract obstruction 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:

prerenal insufficiency. In this form, there is a violation normal functioning due to changes in hemodynamics. Decreased blood flow leads to further development process.
Renal insufficiency. renal tubule damaged by ischemia. The functions of the organ will also be impaired.
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.

Children are cute creatures that quite often make us parents pretty worried. Special attention moms and dads give general condition the health of your loved ones. 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 ailment 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 specialists distinguish two forms this disease are unilateral and bilateral necrosis.

What is renal cortical necrosis?

This condition is characterized by damage to the interlobular arcuate arteries, which can cause the development of ischemic necrosis of the entire renal tissue. We draw your attention to the fact that this pathology is observed, as a rule, in infants only.

What are the causes of papillary and cortical necrosis?

As for the first condition, it occurs as a result of exposure to the body of the child Escherichia coli. Infection can occur both by contact and hematogenous route. If we talk about the reasons for the development of the second state, then in this case It's all due to bacterial infections such as staphylococcus aureus, meningococcal infection, streptococcus and some others.

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

The very first symptoms of this pathology are considered to be a significant deterioration general well-being child on the background of the main ailment. The baby has a fever, chills and oligoanuria. In addition, the face also has hematuria, leukocyturia and bacteriuria. In the urine of such children, you can see separate parts of the renal papillae. In the presence of this disease, the child is also worried about quite strong pain, which can be noted both in the abdomen and in the lower back or in the region of the kidney itself. When passing urine tests, there is also a clear leukocytosis.

What are the symptoms of renal cortical necrosis in children?

To the most frequent signs this disease can be attributed to: hyperazotemia, oligoanuria, electrolyte disorders, as well as some other symptoms that are observed in renal failure. Note that the strength of the manifestation of all these signs directly depends on the degree of the necrotic process.

How are these conditions diagnosed?

To identify these pathologies, such a diagnostic method as excretory urography is used. Excretory urography- this is X-ray method surveys urinary tract, which is based on the ability of the kidney to excrete certain radiopaque substances.

What are the treatments for these ailments?

As for the therapy of papillary necrosis, it provides for the treatment of existing bacterial infection. In this case, the sick child is prescribed medicines with a wide antimicrobial spectrum actions. But in the case cortical necrosis in the very first place, all efforts are directed to the elimination of signs of acute kidney failure. In this case, antibacterial and symptomatic therapy based on the use of antihypertensive and diuretic drugs.

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, 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 cytoplasmic proteins 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 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 cortical substance 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 70% of patients with a similar problem need an organ transplant. For patients with diagnosed necrosis, hemodialysis is vital. In particular severe cases, at untimely treatment, possibly fatal.

AT childhood kidney necrosis occurs as a result of the introduction of bacteria and viruses into the blood, dehydration and acute diarrhea. In adults, it is often caused by bacterial sepsis. In 50% of cases, necrosis affects the kidneys of women with a sudden separation of the placenta, its incorrect location, uterine bleeding etc. Rejection of the transplanted kidney, burns, inflammation in the pancreas, and previous injuries can lead to the development of the disease. Certain diseases also cause necrosis of the epithelium of the convoluted tubules. In this case, patients may not seek help from a specialist for a long time, taking the symptoms of the disease as manifestations of an existing disease. As a result, necrosis takes on a neglected form, which is much more difficult to treat.

Diseases that cause necrosis include diabetes mellitus, prolonged vasospasm, thrombosis, kidney damage, anemia, and infection in the urine. Can provoke the development of the disease frequent use analgesics and actions aimed at dissolving and removing stones from the kidneys. The risk group includes people who have previously received severe injuries and injuries, as well as those who have already undergone surgery for a dissecting aortic aneurysm.

Establishing diagnosis

Necrosis is characterized by gross hematuria, pain in the lower back, decreased diuresis, fever, impaired kidney function in combination with arterial hypertension. However, it should be remembered that these symptoms can often be manifestations of the underlying disease. Help to recognize the disease various methods diagnostics.

Effective Therapy

The basis of the treatment of necrosis of the epithelium of the convoluted tubules is the elimination of the cause this disease. In remission, it is treated according to the symptoms that occur. The therapy promotes better microcirculation, elimination of bacteriuria, dehydration, arterial hypertension. In connection with polyuria, patients are advised to consume salt and water.

In the event of complications associated with ureteral resistance, massive hematuria, a patient in urgently hospitalized. To restore the passage of urine, catheterization of the pelvis and the imposition of a nephrostomy are performed. The patient is prescribed antibiotics. In acute renal failure, hemodialysis is performed.

Prevention of the disease includes the treatment of diseases that cause necrosis of the renal nipples, and rational use analgesics.