Kidney infarction, like any other disease, overtakes a person suddenly. A man or woman may not even suspect that a blood clot has matured in a vein on the leg, which will soon come off and enter the renal artery. This will cause acute circulatory disorders and necrosis of the parenchyma site. But it will be later, and at this moment a person sits, lies or goes to work and feels great. Or not?
Definition
Kidney infarction is a rare urological disease, which is accompanied by the death of organ cells as a result of cessation of blood circulation in the renal artery or its branches. Most often, this pathology occurs in people of mature and old age. Pathophysiologists attribute this to the fact that concomitant diseases that appear in a person with age create favorable conditions for the development of a heart attack.
If the vessels are almost clogged on both sides, then the patient is expected to die. It can occur both from acute intoxication with metabolic products, and from poisoning with toxins that enter the bloodstream from a dead organ. The danger of death is also present with a unilateral lesion if the patient has concomitant kidney diseases.
Types of kidney infarction
In adults, hemorrhagic and ischemic kidney infarction is isolated. Its appearance depends on the mechanism of necrosis formation.
The appearance of hemorrhagic infarction is associated with impaired function of the venous network. Blockage of these vessels leads to stagnation of blood in the organ above the site of injury. Cells that do not receive nutrition quickly die, and venous blood continues to accumulate and permeate the tissues of the kidney. This area of the parenchyma will be stained purple-red. Such a development of the pathological process is not typical for the kidneys, but sometimes it does occur.
Ischemic infarction of the kidney occurs when the arterial bed is blocked. The parenchyma of the kidney ceases to be supplied with blood, its ischemia occurs. The area that becomes necrotic becomes pale to white.
Features of blood flow significantly affect the type of infarction. As a rule, the dead area is a cone with its apex facing the hilum of the kidney, since it is there that the renal artery divides into its branches. Around the white area there are many small hemorrhages. This is due to the fact that the capillaries first spasm and then expand dramatically.
Kidney infarction in a child
Symptoms of a sore kidney are also possible in children. They usually occur in babies with congenital heart defects or when the valvular apparatus is damaged due to rheumatism. In addition, they have a condition such as uric acidkidney infarction.
Uric acid infarction occurs exclusively in newborns, so it is, for the most part, the concern of neonatologists. After birth, the child must adapt to existence outside the mother's body, which does not always pass without a trace for him. Since the buffer systems of the blood are not yet perfect, and the portions of urine are too small, s alts of uric acid may fall out in the renal parenchyma.
As you grow older, the effects of these heart attacks disappear, and they no longer pose any danger. A heart attack that lasts longer than the tenth day of a child's life can be considered pathological.
Causes of disease
Strange as it may seem, but an adult can be diagnosed with uric acid kidney infarction. The causes of this condition are associated with diseases such as gout or oncological processes.
Clogging of the kidney vessels occurs due to the circulation of emboli in the circulatory system. They appear in cardiac pathologies: atrial fibrillation, mitral defects, atherosclerosis, periarteritis nodosa, myocardial infarction, aortic thrombosis and infective endocarditis.
Also, kidney infarction can occur in people who have undergone surgery on the renal arteries. In obstetrics and traumatology, such a pathology as DIC is also considered. In simple terms, this is the appearance of multiple small blood clots against the background of hypocoagulation. For patients in this case, necrosis is characteristic, in which the affected area is the cortical layer.
Clinic
Symptoms of a sore kidney depend on how many nephrons have died. If necrosis does not exceed a few millimeters in volume, then a person may not even guess about it. But with large lesions, the onset of symptoms will not be long in coming.
First of all, there is pain in the lower back. Then the temperature rises to thirty-eight degrees in patients. This is how inflammation manifests itself, which develops in the necrosis zone on the second or third day after the development of ischemia. The patient complains of feeling chills, fatigue, drowsiness, nausea. In the urine, blood clots will be visible to the naked eye. This state will continue for about five more days. In response to a decrease in blood flow in the kidneys, due to the work of compensatory systems, blood pressure will steadily increase.
Such symptoms predominate in ischemic necrosis, but hemorrhagic ischemia is much more severe. Symptoms may not be noticeable at first, but gradually the temperature rises to 39-40 degrees, weakness, anxiety and insomnia join this. Lying on your back is almost impossible. The blood in the urine is so pronounced that the liquid resembles meat slops, and its clots can block the urethra. The amount of urine drops sharply to 150 milliliters per day. This suggests that the body continues to poison itself with metabolic products.
In newborns, the general condition does not suffer, but the color of the urine changes from yellow to brick. This always causes parents to panic.
Complications
It is not the heart attack of the kidney that is terrible. Symptoms, of course, are not pleasant, but at the same time, with good treatment, all lost functions can be restored. It is more dangerous when the pathology was not diagnosed in time or the volume of the lesion is so large that the remaining working tissue cannot cope with the amount of toxins.
After a heart attack, the damaged area is sclerosed and replaced by connective tissue. This leads to a decrease in kidney function and, as a result, to acute or chronic renal failure. Such people are forced to go to dialysis sessions three times a week, and their lives are constantly chained to a medical facility that has the necessary equipment.
Diagnosis
Kidney infarction is a fairly rare disease with blurred clinical symptoms, so it is quite difficult to identify it. In order to make a diagnosis, the doctor collects a detailed history. Asks the patient about medication, surgery and other details.
It is important to tell your doctor if you have rheumatism, endocarditis, or heart defects, as these can also cause thrombosis. General blood and urine tests, as well as blood biochemistry, will help to understand the level of toxins in the body. An increase in lactate dehydrogenase is a specific marker of kidney damage. The presence of blood in the urine is a direct indication for cystoscopy. This is to rule out other sources of bleeding, such as from the urethra or bladder.
Instrumental research helpsvisualize renal infarction. Ultrasound of the abdominal organs with dopplerography allows you to examine the area of necrosis and check the level of blood flow in it. In addition, vascular lesions can be seen using angiography. But this is an invasive method that is not suitable for everyone.
Treatment
What is recommended to do after a kidney infarction is diagnosed. Treatment can only be carried out in a hospital, under the supervision of doctors, since the patient must comply with strict bed rest. The head doctor in this case will be a urologist, but if necessary, a surgeon or therapist can be connected.
Conservative therapy involves restoring blood flow by dilating blood vessels or by dissolving the embolus (if possible). Assign thrombolytics and anticoagulants of direct and indirect action. It is better to do this as early as possible, until the parenchyma of the organ has had time to finally die. In addition, the pain syndrome is necessarily removed. For this, the patient is given narcotic analgesics. If gross hematuria is massive, then hemostatic drugs are prescribed, for example, Etamzilat. To combat dehydration and to restore the volume of circulating blood, the patient is given intravenous fluids.
Surgical treatment is indicated only in case of a large area of necrosis. If the organ can no longer be saved, then it is removed completely, disconnected from the vascular pedicle. In other cases, balloon angioplasty or thrombus extraction can be dispensed with.
In infants, uric acid infarction resolvesindependently and no specific therapy is required. In order for the uric acid crystals to come out faster, you can supplement the child with water.
Forecast
Kidney infarction is a rather rare and serious disease, but the prognosis is usually favorable. The site of necrosis is replaced with connective tissue over time, and the remainder of the organ is enlarged to compensate for the loss in volume and function. The amount of urine does not change, especially if the paired kidney is he althy.
Because these patients remain at risk of thrombosis and embolism, they are prescribed anticoagulants for years, and sometimes for the rest of their lives. The outcome of a kidney infarction depends on the area of the lesion and the speed of medical care.
Prevention
Kidney infarction is a complication of the pathology of the cardiovascular system, therefore, preventive measures consist in the timely treatment of the primary disease. Be sure to strictly follow all the instructions of the cardiologist, monitor the pressure and visit the doctor regularly. The appearance of massive vegetations, thickening of the veins on the legs or on the abdomen is an alarming sign, you should immediately consult a specialist.
