Necrosis of the kidneys: symptoms, causes, methods of treatment. papillary necrosis. Methods of diagnosis and treatment

Kidney necrosis is a dangerous pathological process, characterized in its course by the development of acute kidney failure when, in the absence of assistance from physicians, failure of the organ itself and a fatal outcome for the patient are not excluded.

What is renal necrosis

Necrosis of the kidney is a pathological process, accompanied in its course by the separation and distribution, excretion of cytoplasmic proteins.

most common cause pathological process there is a circulatory failure or negative impact pathogenic microflora.

Types of pathology

In practice, doctors distinguish 5 types of pathological process.

Necrosis affecting the renal papillae necroticpapillitis- Can be acute or chronic.
tubular view- in this case, the epithelium of the renal canals is damaged.
Cortical view- in this case, there is damage to the tissues and cells of the surface of the organ.
Caseous appearance- rather acts not as an independent pathology, but as a consequence of the disease.
focal view- marked by a point lesion of the glomeruli of the organ and at the same time the kidneys themselves work normally.

The reasons

Each of these types of pathology has its own causes of origin. If it is necrosis affecting the renal papillae - most often the causes of development latest doctors called a failure in the blood flow, as well as a violation of the process of urination, an infectious or purulent nature of the origin of the processes, affecting the organ, toxic damage.

With regard to the root causes of the development of a tubular type of pathology - the reasons for its appearance, doctors call injuries or inflammatory process, squeezing blood vessels, thereby disrupting blood flow, poisoning with medicines or toxins. If we talk about the cortical type, it provokes pathogenic microflora or a state of shock that disrupts blood flow.

Caseous type- it is rather a consequence that shows itself to be a complication after tuberculosis or syphilis, leprosy, and focal - the negative effect of pathogenic microflora and a failure in blood circulation.

Doctors also name other reasons for the development of the pathological process. For example, in a pregnant woman - the latter may be the result of a sudden, pathological separation of the placenta or its incorrect position, heavy uterine bleeding.

In the list of other reasons, doctors also include rejection of a disease that has not taken root in the patient donor kidney and an inflammatory process that affects the pancreas, a snake bite or other poisonous reptile or insect, plus poisoning with poisons.

Diseases such as diabetes mellitus and vasospasm are no less dangerous for the patient, increased viscosity blood, provoking abundant formation of blood clots and atherosclerosis, developing anemia, or infection urogenital systems s.

Symptoms

If we talk about general symptoms ongoing pathological process - the main sign indicating its course is deterioration general condition patient. First of all, the patient's body temperature rises, slightly - up to 37.5-37.8 degrees, holding on for a long time and points to general intoxication organism.

After - bouts of painful contractions develop in lumbar back and cannot be treated with simple painkillers. No less important and hallmark kidney damage and the development of necrosis is the volume of urine excreted - it decreases to pathological volumes and does not exceed more than 50 milliliters per day.

During the examination and laboratory analysis composition of urine - in the latter will be identified increased rates leukocytes. Also in the analysis shows itself and pathogenic microflora and in some cases blood clots.

Diagnostics

For staging correct diagnosis- at the very beginning, the specialist collects an anamnesis, namely, he clarifies a number of symptoms that disturb the patient and comorbidities, diseases, in particular, whether he suffers from diabetes, whether he takes certain medications.

also in without fail collect history of past surgical interventions and injuries, whether there is contact with poisons and toxic substances.

After collecting an anamnesis, a sampling and examination of both urine and blood is carried out. When contentious issues in the study - a specialist prescribes an ultrasound of the kidneys and x-ray studies. Doctors may also do the following tests:

If necrotic papillitis is suspected, x-rays are taken.
The cortical type of necrosis is diagnosed using an ultrasound procedure.
So the tubular type of the pathological process is diagnosed on the basis of the results of laboratory tests - biochemical analysis blood and urine, ultrasound and CT.

Treatment

At the very beginning, doctors eliminate the root cause that provoked the pathological process. After that, the course of therapy itself is prescribed, depending on the type of pathology.

When diagnosing necrotic papillitis - to eliminate the root cause, doctors prescribe antispasmodics. If a blockage of the ureter is diagnosed, a catheter is installed, drugs are prescribed that increase blood flow and strengthen immune system. Antibiotics are prescribed as needed a wide range actions. In the absence of positive dynamics of treatment, the affected kidney is simply removed.
With the development of a cortical type of necrosis, an emergency procedure for hardware restoration of blood flow is used. For removal negative manifestation and the consequences of intoxication - prescribe a course of antibiotics.
When diagnosing damage to the tubules, they prescribe medications that cleanse the body from the effects of intoxication and poisoning, plus supplementing the course with taking antibacterial drugs. Recovery is also important. normal blood flow and nutrition of the organ, as well as prescribe compositions that remove negative symptoms vomiting and nausea.

Consequences and complication

Consequence and negative complication the course of the pathology is the development of renal failure. AT this case the patient shows strong signs intoxication, other organs and systems are affected.

As medical statistics show, 7-8 patients out of 10 with this diagnosis die from blood poisoning and kidney failure, problems cardiovascular system. If the pathology is not detected in a timely manner, do not prescribe a course effective therapy– over time, you may need an organ transplant or developing pathology will provoke fatal outcome.

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, causes this disease, what are? 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 pronounced violation functionality of the organ, due to general violation hemodynamics. This variety often transforms into renal insufficiency, since impaired renal blood flow is the main cause of ischemia.

Renal insufficiency: With this variety, 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 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 because of its incorrect location. Besides this pathology diagnosed with severe uterine bleeding, when filling the artery with amniotic fluid, etc.

Other reasons include: rejection of a non-grafted transplanted kidney, kidney injury, inflammatory diseases pancreas. To provoke a pathological process can be a bite of a poisonous snake, as well as arsenic poisoning.

Necrotizing 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.

Provoke necrosis can be diseases such as diabetes mellitus, prolonged vasospasm, as well as thrombosis, atherosclerosis, anemia, urinary infection and others. There is a high risk of developing acute tubular necrosis in patients who have had severe renal injuries, as well as in those who have undergone surgical operation 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.

At timely handling to the doctor during timely treatment the patient makes a full recovery. Otherwise, the disease can go to a relapsing course with severe attacks. renal colic. Severe course Without the necessary, timely treatment, it can be fatal.

How is kidney necrosis corrected? states

The main thing in the treatment of this disease is the diagnosis, elimination of the underlying pathology that caused necrosis. Spend therapeutic measures aimed at improving, resuming blood microcirculation, eliminating bacteriuria, 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. Medication consists in 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 discussed with you today - 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!

Every person who suffers at least some chronic pathology should be aware of the first signs of kidney tissue death, 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 develop cell system kidneys, and then the destruction of cells.

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

Often, kidney necrosis develops in pregnant women and women in labor, this is due to heavy bleeding from the uterine cavity or premature detachment 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.

Cast toxic substances may perform:

Pesticides that are part of various toxic substances or detergents;
Connections heavy metals, 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 possible cause Acute tubular necrosis can be caused by an injury consisting in severe 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.

Manifested this species necrosis by acute or gradual urinary retention, initially there is blood in the urine, the frequency of urination per day decreases. Very often, patients feel discomfort and severe pain in lumbar region. The patient may have a fever. These 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. The rapid entry of these toxins into in large numbers 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 into the kidneys. normal amount and necrosis sets in.

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 back (lower) pain, abdominal pain, 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

chief etiological factor 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 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 significant rise in body temperature, long time leukocytes and erythrocytes are found in the urine in large quantities.

The diagnosis can be confirmed by performing laboratory and instrumental research. by the most informative method diagnosis is considered needle biopsy kidneys.

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 disease development:

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);
For removal pain syndrome prescribe antispasmodics or non-narcotic / narcotic analgesics.

Surgical interventions are carried out only in severe cases 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.

Forecast at early detection signs of ischemia of the renal tissue is quite favorable. Areas of necrosis as a result of timely and proper treatment thicken 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!

Any disease associated with the renal system and organ directly affects its performance and functionality. Untimely treatment of pathology can lead to the formation of renal failure or cause necrosis of the kidneys. Organ necrosis promotes death healthy cells kidneys, deterioration of the functioning of the organ and intoxication of the body. At untimely treatment or diagnosis, organ loss occurs or death occurs. In this article we will talk about the disease of kidney necrosis, analyze its etiology, symptoms and treatment methods.

Etiology of the disease

The main reason for the formation of the development of the disease is Escherichia coli, which penetrates through the papillae of the kidney along the mucosa of the pelvis by contact. Renal papillary necrosis may be unilateral or bilateral. The disease completely affects the performance of one or more papillae of the organ, giving it pale color separates from adjacent tissue. Affected papillae present with necrotic ulceration, abscess, leukocyte infiltration, or papillary sclerosis. additional development the disease is promoted by a pressure jump in the pelvis and a circulatory disorder in the pyramids of the organ, which leads to the death of healthy cells and a complete disruption of the functionality of the organ and the entire system as a whole.

For information! According to statistics, only 3% of people suffering from pyelonephritis suffer from kidney necrosis.

The main reasons for the formation of pathology are:

circulatory disorders in the brain;
poor blood supply to the renal papillae;
horse racing blood pressure that violate the output of urine;
the presence of ulcers and foci of inflammation in cerebral region body;
intoxication of the renal tissue;
circulatory disorders.

Symptoms of kidney necrosis

Necrosis of the kidneys is caused by damage, increase and separation of the protein in the cytoplasm and the destruction of nephrons. The most common causes of the formation of pathology are the influence of bacteria of infections and impaired blood supply in the organ. There are three types of kidney damage, each of them is characterized by its own symptoms and course:

Perenal insufficiency- is formed due to a decrease in kidney function, a violation of hemodynamics, accompanied by a decrease in blood flow in the kidneys and causes ischemia;
Renal insufficiency- accompanied by a violation of the functionality of the body, damage and destruction of the kidney tissue;
Postrenal insufficiency- accompanied by a violation of the outflow of urine, as a result of which the pelvis overflows with fluid, compresses the organ and ischemia occurs.

For information! Kidney necrosis of the renal form develops after warm ischemia after 25 minutes, and after cold ischemia after 2 hours.

Symptoms of necrosis of the renal papillae also have their differences, which depend on the cause of the pathology:

Acute papillary necrosis accompanied by bouts of pain that are somewhat reminiscent of colic, chills and fever, the presence of blood cells in urine. Within 5 days, renal failure occurs and the patient has a decrease in the amount of urine output or its complete cessation;
Chronic necrosis accompanied by the presence of concretions, increased level leukocytes, proteins.

For information! With sickle cell anemia, the patient does not feel symptoms of chronic necrosis of the renal papillae.

Diagnosis of the disease

Comprehensive diagnosis and correct identification of the diagnosis are completely dependent on the collection of anamnesis. The attending physician conducts an examination, reveals the patient's complaints, the presence of infectious diseases kidney, diabetes, injury or damage. The next stage of diagnosis is the delivery of a laboratory analysis of blood and urine, to identify them. biochemical composition, its changes, as well as determining the level of protein, leukocytes and erythritol.

For information! The laboratory conclusion is obligatory in identifying the diagnosis, because. Ultrasound examination of the kidneys is not able to give an accurate picture of what is happening in the human body.

Diagnosis displays the following changes in the process of the organ and the entire renal system:

Radiography allows you to determine the presence of dead papillae of the kidney;
Ultrasound examination of the organ allows confirming the diagnosis of cortical necrosis;
Tubal necrosis confirmed ultrasound, surrender general analysis urine, blood, X-ray and computed tomography.

Treatment of renal necrosis

Elimination of foci of inflammation and destruction of the renal tissue, tubules and the organ itself is main task specialists. The method of treatment is prescribed based on the type of pathology and the reasons for its formation. Treatment Methods renal necrosis:

Treatment of renal necrosis is to eliminate the cause of the formation of the disease, as a rule, antispasmodics are prescribed. In case of blockage of the ureters, catheters are installed to collect fluid, and drugs are also prescribed that strengthen the immune system, restore internal blood supply and broad spectrum antibiotics.
The treatment of cortical necrosis consists in restoring the internal blood supply to the kidney tissue, bacteria, and the infection is removed with antibiotics, and an artificial kidney is used to purify the blood.

For information! If a drug therapy did not bring a high result, the organ is completely removed.

Treatment of damaged tubules is performed with the help of medicines causing intoxication. To eliminate bacteria, infections, antibiotic therapy is prescribed, restores internal blood supply, strengthens the immune system, cleanses the body of accumulated toxins, and prescribes drugs that eliminate bouts of vomiting and nausea.

For information! Restoration of the passage of urine is performed by introducing a catheter, nephrostomy and antibiotic therapy.

You can learn more about the methods for diagnosing kidney necrosis from the video

Early diagnosis of the disease gives good predictions for the restoration of the organ's performance and return to normal life sick. However, patients are often given an organ transplant or permanent dialysis therapy that performs kidney function. Modern techniques treatment and diagnosis can avoid complications and the formation of kidney necrosis. The recovery process depends entirely on timely consultation, the correct prescription of treatment and the stage of the disease. Remember, the main task of treatment is to suppress inflammation, eliminate bacteria, infections and increase the body's reactivity.

RENAL NECROSIS (PAPILLARY AND CORTICAL)(synonyms: papillonekrosis, necrotizing pyelonephritis).

RENAL NECROSIS. Papillonekrosis. Etiology and pathogenesis. Most often seen as a complication various diseases(pyelonephritis, diabetes mellitus, nephrolithiasis, etc.), less often - as a primary kidney lesion. In adults, a common cause of papillonecrosis is analgesic nephropathy resulting from long-term use analgesics. The leading role in the development of the disease belongs to coli, which penetrates into the papillae of the kidneys more often by contact(from the mucous membrane of the pelvis), in some patients - by the hematogenous route. The development of the disease is facilitated by an increase in pressure in the pelvis, followed by circulatory disorders in the pyramids of the kidneys, which can also be observed with hypertension, thrombosis, etc. Papillary necrosis can be one- or two-sided, accompanied by damage to one or more papillae, which are characterized by sharp pallor and are clearly demarcated from the adjacent tissue. Abscesses and an ulcerative necrotic process with rejection of the affected areas are often found in them. Morphologically, there is significant neutrophilic infiltration in the affected papillae, with protracted course diseases - sclerosis.

RENAL NECROSIS (Papillonekrosis) - clinical picture. Main clinical signs are an acute onset with a deterioration in the general condition against the background of the underlying disease (diabetes mellitus, etc.), severe pain in the lumbar region high fever, chills, oliguria and other symptoms of acute renal failure. Severe leukocyturia and bacteriuria, hematuria, and sometimes pieces of renal papillae in the urine are observed. Possible recovery, death, as well as the transition to a relapsing course, characterized by bouts of pain in the abdomen, lower back, in the area of the affected kidney and ureter. Relapses usually occur during an exacerbation of the underlying disease and under the influence of other factors (overwork, infections, etc.). During this period, the ESR is increased, leukocytosis, limitation of tubular functions and glomerular filtration in some patients. At excretory urography deformation of the cups is detected, in late stages- a picture of chopped off papillae.

NECROSIS OF THE KIDNEY (Papillonekrosis) - d diagnoz. Based on sudden appearance septic condition and signs of acute renal failure in the presence of severe urinary syndrome.

Papillonecrosis must be differentiated from acute pyelonephritis, urolithiasis complicated by bacterial infection.

Treatment. should be sent for elimination. bacterial infection using drugs with a wide antimicrobial spectrum of action, which have minimal or moderate nephrotoxicity and do not cause allergic reaction in a particular patient. Gentamicin (0.4 mg / kg 2 times a day), erythromycin (at the age of 2 years - 5-8 mg / kg 4 times a day, after 2 years - 0.5-1.0 g / day) and other drugs are prescribed in courses of 7-10 days. With recurrent papilnecrosis, in addition to repeated courses antibiotic therapy, it is necessary to carry out measures to increase the reactivity of the body. The development of acute renal failure requires appropriate tactics.

RENAL NECROSIS. Cortical necrosis of the kidneys. It is observed mainly in infancy against the background of a bacterial infection (streptococcus, staphylococcus, intestinal and meningococcal infection etc.) and is caused by damage to the interlobular and arcuate arteries, leading to ischemic necrosis of the renal tissue. In the cortical layer of the kidneys, necrosis of glomerular loops is found, total or in the form of foci.

Clinical picture. Clinical manifestations and the outcome of cortical necrosis depend on the extent of the necrotic process. Symptoms of acute renal failure (oligoanuria, hyperazotemia, electrolyte disorders), hematuria are leading in focal and total necrosis, which, as a rule, ends in death. With focal cortical necrosis, reverse development of renal failure and recovery are possible. In such patients, excretory urography after a few months often reveals calcifications at the site of foci of necrosis.

RENAL NECROSIS (Cortical). Treatment. Elimination of signs of acute renal failure with the help of conservative measures and hemodialysis, as well as antibacterial and symptomatic therapy(diuretic and hypotensive drugs, etc.).