Kidney infarction, like any other disease,overtakes a man suddenly. A man or woman may not even suspect that a blood clot has ripened in a vein on the leg, which will soon come off and enter the renal artery. This will cause acute impairment of blood circulation and necrosis of the site of the parenchyma. But it will be later, and at this moment the person sits, lies or goes to work and feels great. Or not?
Definition
Kidney infarction is a rare urologicala disease that 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 elderly age. Pathophysiologists attribute this to the fact that comorbid diseases that occur in humans with age create favorable conditions for the development of a heart attack.
If the vessels are almost clogged on both sides, thenthe patient is fatal. It can occur both from acute intoxication by metabolic products, and from poisoning by toxins that enter the blood from the dead body. The risk of death is also present in unilateral lesions if the patient has concomitant kidney disease.
Types of kidney infarction
In adults, hemorrhagic and ischemic kidney infarction are isolated. Its appearance depends on the mechanism of necrosis formation.
Появление геморрагического инфаркта связано с dysfunction of the venous network. The 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 saturate the kidney tissue. This area of the parenchyma will be colored purple-red. Such a development of the pathological process is not characteristic of the kidneys, but sometimes it does occur.
Ischemic kidney infarction occurs whenoverlap of the arterial bed. The kidney parenchyma stops blood supply, ischemia occurs. The area that is necrotizing acquires a pale tint, down to whiteness.
Blood flow characteristics significantly affect the typeheart attack. As a rule, the dead area is a cone, which faces apex at the gate of the kidney, since the renal artery is divided into its branches there. 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 heart attack in a child
Symptoms of a sick kidney are also possible in children.They are usually found in babies with congenital heart defects or if the valve apparatus is affected due to rheumatism. In addition, they have such a condition as urinary acid infarction of the kidney.
Urinary acid infarction occurs exclusively innewborns, so this is, for the most part, the care of neonatologists. After birth, the child must adapt to the existence of the mother outside the body, which does not always pass for him without a trace. Since the buffer systems of the blood are not perfect yet, and the urine portions are too small, uric acid salts may fall out in the renal parenchyma.
As they grow older, the consequences of these heart attacks disappear, and they no longer pose any danger. Pathological can be considered a heart attack that lasts longer than the tenth day of the child's life.
Causes of the disease
Strange as it may seem, an urate acid kidney infarction can also be diagnosed in an adult. The causes of this condition are associated with diseases such as gout or cancer.
Закупорка сосудов почки возникает из-за circulating in the circulatory system emboli. 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 peoplewho underwent surgery on the renal arteries. In obstetrics and traumatology, such pathology as DIC is also considered. In simple terms, this is the appearance of multiple small blood clots on the background of hypocoagulation. For patients in this case, characterized by necrosis, in which the affected area is the cortical layer.
Clinic
The symptoms of a painful kidney depend on whichthe number of nephrons managed to die. If the necrosis does not exceed several millimeters in volume, then the person may not even guess about it. But with large lesions, the onset of symptoms does not take long.
First of all, there is pain in the lower back.Then the patient's temperature rises to thirty-eight degrees. This is the manifestation of inflammation that 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. Blood will be visible in the urine with the naked eye. This condition will last for about five 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 ischemicnecrosis, but hemorrhagic ischemia appears much harder. Symptoms may not be noticeable at first, but gradually the temperature rises to 39–40 degrees, weakness, anxiety and insomnia join. Lying on your back is almost impossible. Blood in the urine is so pronounced that the liquid resembles meat slop, and its clots can block the urethra. The amount of urine is sharply reduced 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 urine changes from yellow to brick. It always causes panic in parents.
Complications
Not the kidney infarction is terrible.The 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 does not cope with the amount of toxins.
After a heart attack, the damaged areasclerosed and replaced by connective tissue. This leads to a decrease in renal function and, as a consequence, 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 the hospital, where there is the necessary equipment.
Diagnostics
Инфаркт почки – это достаточно редкое заболевание with erased clinical symptoms, so it is difficult to identify it. In order to make a diagnosis, the doctor collects a detailed history. He asks the patient about taking medications, surgeries and other details.
It is important to tell the doctor about the presence of rheumatism,endocarditis or heart disease, as they can also cause thrombosis. General blood and urine tests, as well as blood biochemistry, will help to understand what level of toxins are in the body. Increased lactate dehydrogenase is a specific marker of kidney damage. The presence of blood in the urine is a direct indication for cystoscopy. This is necessary to eliminate other sources of bleeding, for example, from the urethra or bladder.
Instrumental studies helpvisualize kidney infarction. Ultrasound examination of the abdominal organs with dopplerography makes it possible to examine the area of necrosis and check the level of blood flow in it. In addition, vascular lesions can be seen with angiography. But this is an invasive method that is not suitable for everyone.
Treatment
What is recommended to do afterdiagnosed with kidney infarction. Treatment can be carried out only in the hospital, under the supervision of doctors, as the patient must observe strict bed rest. In this case, the urologist will be the chief physician, but if necessary, a surgeon or therapist can be connected.
Conservative therapy involvesrestoration of blood flow by dilating the 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, before the parenchyma of the organ finally died. In addition, pain is necessarily removed. For this, the patient is given narcotic analgesics. If gross hematuria is massive, then hemostatic agents are prescribed, for example, etamzilat. To combat dehydration and to restore the volume of circulating blood, intravenous fluids are given to the patient.
Surgical treatment is indicated only in the case oflarge area of necrosis. If the organ is no longer salvaged, then it is removed completely, detaching it from the vascular pedicle. In other cases, balloon angioplasty or blood clot extraction can be dispensed with.
In infants, urinary acid infarction is taking place independently and no specific therapy is required. In order for the uric acid crystals to come out faster, you can dope the child with water.
Forecast
Kidney infarction - quite rare and severedisease, but the prognosis is usually favorable. The site of necrosis is replaced with connective tissue over time, and the remaining part 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 healthy.
Since these patients remain at riskthrombosis and embolism, they are appointed anticoagulants for years, and sometimes until the end of life. The outcomes of kidney infarction depend on the area of damage and the speed of medical care.
Prevention
Kidney infarction is a complication of pathologycardiovascular system, therefore, preventive measures consist in the timely treatment of the primary disease. It is imperative that you strictly follow all the instructions of the cardiologist, monitor the pressure and regularly visit the doctor. The appearance of massive vegetations, thickening of the veins on the legs or on the abdomen - this is an alarming sign, you should immediately consult with a specialist.
