Kidney infarction, like any other disease, overtakes a person suddenly. A man or woman may not even suspect that a blood clot has ripened in a leg vein, which will soon come off and enter the renal artery. This will cause acute circulatory failure and necrosis of the parenchyma. But it will be later, and at this moment a person sits, lies or goes to work and feels excellent. Or not?
Definition
Kidney infarction is a rare urological disease, which is accompanied by the death of organ cells as a result of the 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, the patient expects a fatal outcome. It can occur both from acute intoxication with metabolic products, and from poisoning with toxins that enter the bloodstream from a dead organ. There is a danger of death with a unilateral lesion, if the patient has concomitant kidney disease.
Types of Kidney Infarction
In adults, hemorrhagic and ischemic infarction of the kidney is isolated. Its appearance depends on the mechanism of necrosis formation.
The appearance of hemorrhagic heart attack 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 damage. Cells that do not receive nutrition die quickly, and venous blood continues to accumulate and impregnate kidney tissue. This area of the parenchyma will be colored purple-red. For the kidneys, such a development of the pathological process is not characteristic, but sometimes it still occurs.
Ischemic infarction of the kidney occurs when the arterial bed is blocked. The parenchyma of the kidney stops supplying blood, its ischemia sets in. The area that is necrotic becomes pale in color, down to whiteness.
Features of blood flow significantly affect the type of heart attack. As a rule, the necrotic site is a cone with its apex facing the gate of the kidney, since the renal artery divides into its branches there. Around the white area there are many small hemorrhages. This is due to the fact that the capillaries are first spasmodic, and then sharply expand.
Kidney infarction in a child
Symptoms of an aching kidney are also possible in children. Usually they are found in babies with congenital heart defects or with damage to the valve apparatus due to rheumatism. In addition, they have a condition such as uric acid infarction of the kidney.
Uric acid infarction occurs exclusively in newborns, so this 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 blood buffer systems are not yet perfect, and the urine portions are too small, uric acid salts may precipitate in the renal parenchyma.
As they grow older, the consequences 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 the disease
Oddly enough, but in an adult, a uric acid infarction of the kidney can be diagnosed. The causes of this condition are associated with diseases such as gout or oncological processes.
Blockage of the vessels of the kidney 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 infectious endocarditis.
Kidney infarction can also occur in people who have had surgery on the renal arteries. In obstetrics and traumatology, a pathology such 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, 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 several millimeters in volume, then a person may not even be aware of it. But with large lesions, the onset of symptoms will not take long.
First of all, there is pain in the lower back. Then the patient rises to thirty-eight degrees. So manifests inflammation, which develops in the area of necrosis on the second or third day after the development of ischemia. The patient complains of a feeling of chills, fatigue, drowsiness, nausea. Blood clots will be visible in the urine with the naked eye. This condition will last another five days. In response to a decrease in blood flow in the kidneys due to the work of compensatory systems, blood pressure will increase steadily.
Such symptoms predominate with 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 in. Lying on your back is almost impossible. 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 urine changes from yellow to brick. This always causes a panic in parents.
Complications
The heart attack of the kidney is not 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 lesion is so large that the remaining working tissue can not 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 renal 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 life is constantly confined to a medical institution where there is the necessary equipment.
Diagnostics
Kidney infarction is a rather rare disease with erased clinical symptoms, so it is difficult to identify it. In order to make a diagnosis, the doctor collects a detailed history. Asks the patient about taking medications, previous surgery and other details.
It is important to tell the doctor about the presence of rheumatism, endocarditis or heart defects, as they 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 necessary to exclude other sources of bleeding, for example, from the urethra or bladder.
Instrumental studies help visualize a heart attack of the kidney. Ultrasound of the abdominal cavity with dopplerography allows you to examine the site 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 does not suit everyone.
Treatment
What is recommended to be done after a kidney heart attack 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 chief doctor in this case will be a urologist, but if necessary, a surgeon or therapist can connect.
Conservative therapy involves the restoration of blood flow by dilating blood vessels or by dissolving the embolus (if possible). Thrombolytics and anticoagulants of direct and indirect action are prescribed. This is best done as early as possible, until the organ parenchyma has completely died. In addition, the pain syndrome is necessarily removed. For this, the patient is given narcotic analgesics. If the macrohematuria is massive, then hemostatic drugs are prescribed, for example, Ethamsylate. To combat dehydration and to restore the volume of circulating blood, the patient is given intravenous fluids.
Surgical treatment is indicated only in the case of a large zone of necrosis. If the organ can no longer be saved, then it is completely removed, disconnecting from the vascular pedicle. In other cases, balloon angioplasty or thrombus extraction can be dispensed with.
In infants, uric acid infarction passes independently and no specific therapy is required. In order for uric acid crystals to come out faster, you can milk the child with water.
Forecast
Kidney infarction is a rather rare and serious disease, but the prognosis is usually favorable. The area of necrosis is replaced with connective tissue over time, and the remaining part of the organ increases 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 have a risk of thrombosis and embolism, they are prescribed anticoagulants for years, and sometimes until the end of life. The outcome of a kidney infarction depends on the area of damage and the speed of medical care.
Prevention
Kidney infarction is a complication of the pathology of the cardiovascular system, so preventive measures consist in the timely treatment of the primary disease. Be sure to strictly comply with all the instructions of a cardiologist, monitor the pressure and regularly visit a doctor. The appearance of massive vegetation, thickening of the veins on the legs or stomach is an alarming sign, you should immediately consult a specialist.