Kidney necrosis: symptoms, causes, treatment methods. Papillary and cortical necrosis of the kidneys in children

Kidney necrosis is extremely dangerous condition, in which the development of acute renal failure syndrome is possible.

In the absence of emergency medical care in a hospital setting, organ loss and even death cannot be ruled out.

The kidneys are located on both sides of the spine at the level lumbar region. It borders on the liver from above, so it is anatomically located slightly below the left.

Human kidneys

On the outside they are covered with adipose tissue, under which there is a dense, poorly extensible fibrous capsule. It is connected to the parenchyma, in which two layers are distinguished - the outer cortex and the inner medulla.

The parenchyma contains about a million functional kidney cells - nephrons; they consist of a glomerulus and a system of tubules. Their main function is to filter blood plasma to form urine.

The medulla of the parenchyma forms so-called pyramids. In each kidney there are from 8 to 12. Urine passes through the nephron tubules into the collecting ducts, which exit to the top of each pyramid - the papilla.

The papillary openings open into the cavity of the renal calyces. In turn, they are combined into a pelvis. From the pelvis, urine flows through the ureters into bladder and by urethra excreted from the body.

Kidney functions

The main function is to filter the blood from toxic end products of metabolism and remove them in the urine.

Kidney functions

In addition to this, the kidneys also:

• excrete drugs and toxins that enter the body in the urine;
• maintain acid-base balance;
• regulate the content of electrolytes in the blood (sodium, potassium, chlorine, calcium);
• participate in maintaining normal level blood pressure;
• secrete some biologically active substances (renin, erythropoietin, prostaglandins).

Therefore, disruption of their work affects the general condition of the entire body. One of the most dangerous is necrosis.

This is the irreversible death of cells and organ tissues. Depending on the location of its localization, necrotic papillitis, acute tubular (tubular) and cortical necrosis are distinguished.

Necrotizing papillitis

This is called necrosis of the renal papillae. This condition occurs as a complication of acute pyelonephritis.

Kidney inflammation

Pyelonephritis is caused by bacteria in the calyces and pelvis.

Pathogenic microorganisms can enter the circulatory system of the medulla of the kidney and clog the vessels. In this case, necrosis develops as a result of impaired blood supply.

In addition, the infiltrate formed during inflammation can block the ureter. In this case, the outflow of urine is sharply disrupted, and it begins to accumulate in the calyces and pelvis.

As a result, they increase in volume and begin to put pressure on the parenchyma, causing necrosis.

With papillitis, blood appears in the urine. It might start renal colic. Specific sign is the presence of a dead papilla in the urine. An x-ray is taken to confirm the diagnosis.

To stop necrosis, first eliminate its cause. For example, if the ureter is blocked, antispasmodics are prescribed or catheterization is performed.

Also used are drugs that restore and enhance blood circulation, antibiotics wide range actions, immunostimulants and immunomodulators.

Kidney pathologies

If drug therapy is ineffective, and necrosis continues to develop, then an operation (nephrectomy) is performed.

Necrotic lesion of the cortex

Acute cortical necrosis develops with prolonged absence of blood circulation in the cortical layer of the parenchyma.

It can occur in newborns with prolonged asphyxia, congenital defects hearts, premature birth with placental abruption, impaired blood supply to the uterus in a pregnant woman, severe bacterial sepsis.

The diagnosis of cortical necrosis is made based on the results of ultrasound examination. A favorable treatment outcome depends on the degree of kidney damage.

Doctors restore blood supply, if possible, of course, perform hemodialysis, and prescribe antibacterial drugs.

After cortical necrosis, the risk of developing chronic renal failure is high.

Necrotic process in tubules

Tubular or tubular necrosis is damage to the cells of the nephron tubules.

Injuries and blood loss

Necrosis begins for several reasons:

• circulatory disorders in the kidney;
• compression of the tubular system;
• toxic effects.

Circulatory problems may occur when heavy bleeding after injury or during surgery, with blood vessels (for example, scleroderma, thrombosis).

Necrosis of the nephron tubules can begin due to their mechanical compression due to severe trauma, increased pressure inside the kidney itself due to blockage of the ureter and disruption of the outflow of urine.

This picture is typical for acute bacterial kidney infections.

The following have a pronounced nephrotoxic effect:

• heavy metals (bismuth, mercury, arsenic, lead, gold);
• pesticides;
• fungicides;
• organic solvents (for example, ethylene glycol);
• the venom of some snakes.

Medicines

It is also worth noting that many antibiotics antivirals, chemotherapy and radiocontrast drugs also have Negative influence on the kidneys, so patients with nephrological diseases should be prescribed them with extreme caution and careful dosage calculation.

With tubular necrosis, acute renal failure develops. All Clinical signs This process is caused by poisoning of the body with metabolic products.

These are nausea, vomiting, loss of appetite, drowsiness, lethargy, abdominal pain, enlarged liver.

The diagnosis is made on the basis of general and biochemical analysis urine, ultrasound results, x-rays, computed tomography.

When treating tubular necrosis, first of all, they fight its cause.

This is the restoration of renal blood flow, or the removal of toxins using plasmapheresis or hemofiltration, and the immediate cessation of taking medications with nephrotoxic effects.

At infectious lesion antibacterial therapy is carried out.

Then the patient is prescribed a diet and restoratives.

As a result of complications of certain diseases, injuries, and blood poisoning, kidney necrosis may occur. This dangerous pathology, causing kidney failure. In this case, the death of kidney tissue cells is observed. The functioning of the organ deteriorates, and signs of poisoning appear. If you do not go to the hospital in time, the disease will lead to kidney loss or death.

The death of kidney cells is a consequence of complications of diseases internal organs or the result of external influence.

Description of the pathology

With kidney necrosis, cytoplasmic proteins are damaged. As a result, organ cells are destroyed and tissue areas die. Pathology occurs in both adults and infants. The main causes of the disease are considered:

• infections, sepsis;
• sudden separation of the placenta in pregnant women;
• injuries, bleeding;
• rejection of a transplanted kidney;
• complications of cardiovascular diseases;
• poisoning chemicals, snake bite.

There are the following types of necrosis:

1. Prerenal failure. As a result, circulatory disorders worsen functional abilities kidneys Since impaired blood flow leads to ischemia (death of a tissue area), this type of pathology develops into renal failure.
2. Renal failure. It is characterized by a malfunction of the kidney due to damage to its tissue. The main cause of the pathology is ischemia (warm or cold).
3. Postrenal failure. Kidney function is normal. Due to damage urinary tract urination is difficult or absent. If compression of the kidney parenchyma occurs due to accumulated urine and bleeding occurs, this type of necrosis develops into renal failure.

Papillary necrosis (papillonecrosis)

The main causes of papillary necrosis are circulatory disorders and complications of pyelonephritis.

Papillary necrosis or necrotizing pyelonephritis is characterized by necrosis of the renal papillae and renal medulla. As a result, the functioning of the organ is disrupted; morphological changes. According to statistics, this pathology is observed in 3% of people suffering from pyelonephritis. This pathology is diagnosed in women 2 times more often than in men.

Causes of pathology:

• IN brain section blood circulation is impaired.
• The renal papillae are not sufficiently supplied with blood. This occurs due to compression of blood vessels by edema, inflammatory processes, vascular sclerosis (blockage of the vessel bed cholesterol plaque), regardless of their location (in or outside the kidney).
• Because of high pressure V renal pelvis the outflow of urine is disrupted.
• Foci of inflammation, ulcers in the brain part of the organ.
• Poisoning of kidney tissue by toxins.
• Violation of the blood picture.

With necrosis of the renal papillae, the symptoms differ depending on the form of the pathology:

• Acute papillary necrosis is manifested by colic-like pain, severe fever and chills. There is blood in the urine. It develops over 3-5 days, with little urine being excreted or urination stops.
• Chronic necrosis of the renal papillae is manifested by the presence of blood and leukocytes in the urine. Mild pain appears periodically. Accompanied by repeated infectious diseases of the urinary tract and the formation of stones. With sickle cell anemia, there are no pathological symptoms.

As a result of blockage blood vessels, through which nutrition is delivered to the renal cortex, outer part the organ dies. The functioning of the kidney is impaired and failure occurs. 30% of cases of this disease occurs due to sepsis (blood poisoning). In addition, pathology is caused by rejection of a transplanted kidney, injuries and burns, and chemical poisoning.

Necrosis of the cortical layer develops as a result of circulatory disorders in the renal cortex and is complicated by acute renal failure.

Pathology can affect anyone, regardless of age. A tenth of cases of the disease are diagnosed in newborns. This is associated with premature placental abruption, sepsis, dehydration, shock, and infection. Together with the child, his mother often suffers. In women, half of the cases of this disease are postpartum complication. Pathology develops due to early abruption or improper location of the placenta, uterine bleeding, infection introduced during childbirth, blockage of arteries with fluid from the amnion (the membrane in which the embryo is located). Tubular necrosis is a lesion renal tubules chemical and mechanical nature.

In tubular necrosis, it affects epithelial tissue renal tubules. In this case, there are 2 types of disease, depending on the causes:

• Ischemic necrosis is provoked by trauma, inflammatory processes, sepsis, shock, low content oxygen in the blood.
• Nephrotoxic necrosis occurs as a result of poisoning of tissues and cells by toxins, heavy metals, antibiotics, etc.

Acute tubular necrosis means mechanical damage renal tubules due to “desquamation” of the epithelium. This pathology damages the tubular cells themselves and is accompanied by acute inflammatory process. The result is severe damage to the kidney tissue and changes in the structure of the organ, leading to kidney failure.

Symptoms of the pathology depend on the degree of organ damage. The most commonly observed signs are:

• coma;
• drowsiness;
• delirium (defeat nervous system toxins);
• swelling;
• weak urination;
• nausea, vomiting.

Children are cute creatures who quite often make us parents quite worried. Special attention moms and dads pay general condition health of your beloved children. This is not surprising, since only healthy baby can be truly happy. Unfortunately, things don't always work out well. Certain illnesses quite often burst into a child’s life, and quite suddenly. Those children who adhere to all the rules of a healthy lifestyle every day are no exception..site) will talk about diseases such as papillary and cortical necrosis kidneys in children. After reading the information presented, you can find out everything you need about the causes of development, symptoms, diagnosis, as well as methods of treatment for these ailments.

What is papillary renal necrosis in children?

In fact this 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 primary disease kidney This disease refers to a condition in which there is a clear circulatory disorder directly in the kidney pyramids. Modern doctors and specialists distinguish two forms of this disease - unilateral and bilateral necrosis.

What is cortical renal necrosis?

What are the causes of the development of papillary and cortical necrosis?

What is the clinical manifestation of renal papillary necrosis?

What are the symptoms of cortical renal necrosis in children?

How are these types of conditions diagnosed?

What are the treatment methods for these ailments?

Any disease associated with the renal system and organ directly affects its performance and functionality. Untimely treatment of the pathology can lead to renal failure or cause kidney necrosis. Necrosis of the organ contributes to the death of healthy kidney cells, deterioration of the functioning of the organ and intoxication of the body. If treatment or diagnosis is not timely, organ loss or death occurs. In this article we will talk about the disease kidney necrosis, analyze its etiology, symptoms and treatment methods.

Etiology of the disease

The main reason for the development of the disease is coli, which penetrates through the renal papillae through the mucous membrane of the pelvis by contact method. Renal papillary necrosis can be unilateral or bilateral. The disease completely affects the performance of one or more papillae of the organ, gives it a pale color, and separates it from the adjacent tissue. In the affected papillae there is an ulcerative-necrotic process, an abscess, infiltration of leukocytes or sclerosis of the papillae. Additional development of the disease is facilitated by a surge in pressure 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;
• surges in blood pressure that interfere with urine output;
• the presence of ulcers and foci of inflammation in the brain part of the organ;
• intoxication of kidney tissue;
• circulatory disorders.

Symptoms of kidney necrosis

Kidney necrosis is caused by damage, increase and separation of protein in the cytoplasm and destruction of nephrons. The most common causes of pathology are the influence of bacterial infections and impaired blood supply to the organ. There are three types of kidney damage, each with its own symptoms and course:

• Perenal insufficiency- formed as a result of decreased renal function, impaired hemodynamics, accompanied by a decrease in blood flow in the kidneys and causes ischemia;
• Renal failure- accompanied by impaired organ functionality, damage and destruction of renal tissue;
• Postrenal failure- accompanied by a violation of the outflow of urine, as a result of which the pelvis fills with fluid, compresses the organ and ischemia occurs.

For information! Renal necrosis of the kidney develops after warm ischemia after 25 minutes, and after cold ischemia after 2 hours.

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

• Acute papillary necrosis accompanied by attacks of pain that are somewhat reminiscent of colic, chills and fever, and the presence of blood cells in the urine. Within 5 days, renal failure occurs and the patient experiences a decrease in the amount of urine output or its complete cessation;
• Chronic necrosis accompanied by the presence of stones, 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 diagnostics and correct identification of the diagnosis depend entirely on the collection of anamnesis. The attending physician conducts an examination, identifies the patient’s complaints, the presence infectious diseases kidney, diabetes mellitus, injury or damage. The next stage of diagnosis is to pass laboratory analysis blood and urine, to identify their biochemical composition, its changes, as well as determine the level of protein, leukocytes and erythritol.

For information! A laboratory report is mandatory when identifying a diagnosis, because Ultrasound examination of the kidneys is not able to give an accurate picture of what is happening in the human body.

Diagnosis reflects the following changes in the functioning of the organ and the entire renal system:

• X-ray can determine the presence of dead renal papillae;
• Ultrasound examination of the organ can confirm the diagnosis of cortical necrosis;
• Tubular necrosis confirmed ultrasound examination, change general analysis urine, blood, x-ray and computed tomography.

Treatment of renal necrosis

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

• Treatment of renal necrosis consists of eliminating the cause of the disease; as a rule, antispasmodics are prescribed. In case of blockage of the ureters, catheters are installed to collect fluid, and medications are also prescribed to strengthen the immune system, restoring internal blood supply and broad-spectrum antibiotic therapy.
• Treatment of cortical necrosis consists of restoring the internal blood supply to the renal tissue, bacteria, and the infection is removed with the help of antibiotics; an artificial kidney is used to cleanse the blood.

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

• Treatment of damaged tubules is performed using medicines, causing intoxication. To eliminate bacteria and infections, antibiotic therapy is prescribed, internal blood supply is restored, the immune system is strengthened, the body is cleansed of accumulated toxins, and medications are prescribed that eliminate attacks of vomiting and nausea.

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

More information about methods for diagnosing renal necrosis can be found in the video

Early diagnosis of the disease gives good prognoses for restoring the functioning of the organ and returning to normal life sick. However, patients are often prescribed an organ transplant or ongoing dialysis therapy, which performs kidney function. Modern techniques treatment and diagnosis help to avoid complications and the formation of kidney necrosis. The recovery process depends entirely on timely consultation, correct purpose treatment and stage of the disease. Remember, the main goal of treatment is to suppress inflammation, eliminate bacteria, infections and increase the body's reactivity.

Spicy tubular necrosis characterized by acute tubular cell damage and dysfunction causing. Frequent causes of acute tubular necrosis- hypotension causing insufficient renal perfusion, and nephrotoxic drugs. The disease is asymptomatic until renal failure develops. The diagnosis of acute tubular necrosis is suspected if azotemia occurs after a period of hypotension or drug exposure and is distinguished from prerenal azotemia by blood and urine test results. symptomatic.

The most common reasons acute tubuary necrosis- hypotension and nephrotoxins. The most common nephrotoxic agents include aminoglycoside antibacterials, amphotericin B, cisplatin, and radiocontrast agents. Large surgical interventions and long-term hepatobiliary pathology, poor perfusion and elderly age increase the risk of aminoglycoside toxicity. Less common causes include topic pigments, poisons, herbal and folk remedies. Certain combinations medicines may be particularly nephrotoxic. Poisons cause focal and segmental occlusion of the tubular lumens by casts, cell decay products, or segmental tubular necrosis. ACC predominantly occurs in patients with creatinine clearance less than 47 ml/min and hypovolemia or poor renal perfusion.

Symptoms diagnosis of acute tubular necrosis

OKN is usually asymptomatic, but may be accompanied by symptoms of acute renal failure, in which oliguria is common. The disease is suspected when the plasma creatinine concentration exceeds the normal range by 0.5 mg/dL per day after a period of hypotension or exposure to a nephrotoxic agent. Increases in creatinine concentrations may occur several days after exposure to some nephrotoxins. Criteria for distinguishing OKN from prerenal azotemia, important for determining treatment, are listed in Table. 236-1.

Prognosis, treatment and prevention of acute tubular necrosis

Prognosis of acute tubular necrosis good in patients without pathology of other organs and systems, when etiological factor eliminated; creatinine concentrations usually return to normal or nearly normal within 1 to 3 weeks. In weakened patients, even with moderate acute renal failure, the risk of complications and fatal outcome rises; the prognosis is better in non-resuscitated patients compared to resuscitated patients. Risk factors for death include oliguria; high severity of the disease; myocardium, or convulsive syndrome; chronic immunosuppression; need in artificial ventilation lungs. Usually the causes of death are infectious complications, the underlying pathology.

Treatment of acute tubular necrosis supportive, includes early withdrawal of nephrotoxic drugs, support of euvolemia and parenteral nutrition. Diuretics are commonly used to maintain diuresis in oliguric acute insufficiency, but their effectiveness has not been proven.

Prevention of acute tubular necrosis includes support for euvolemia and renal perfusion in critically ill patients, avoidance of nephrotoxic drugs when possible, close monitoring of renal function when their use is necessary, and various measures to prevent contrast. Ineffective and possibly harmful means include:

• loop diuretics,
• dopamine,
• natriuretic peptides,
• calcium channel blockers.