Renal papillary necrosis. Kidney necrosis

Necrosis of the renal papillae (necrotizing papillitis or papillary necrosis)- a destructive process, with predominant damage to the renal papillae and leading to pronounced functional and morphological changes in it. The first report about it was made by N. Friedreich (1877) and long time this disease was considered rare. However, research by Yu.A. Pytel (1969) allowed us to establish that necrosis of the renal papillae occurs in 1% of urological patients and more than 3%, while in women it is 2 times more common than in men.

Yu.A. Pytel (1972) grouped all the causes leading to necrosis of the renal papillae as follows:

changes in blood vessels medulla with impaired blood flow in them;
disruption of the blood supply to the renal papilla as a result of compression of blood vessels due to edema, inflammatory and sclerotic changes both inside and outside the kidney;
disturbances in the outflow of urine from the upper urinary tract with the occurrence of intrapelvic hypertension;
purulent-inflammatory processes in the medulla of the kidney;
endogenous and exogenous effects of toxins on the renal parenchyma;
change in blood composition.

One of reasons for the development of papillary necrosis The author considers the renal papilla to be a peculiar blood supply. It is carried out due to direct false vessels extending from the efferent arteries of the juxtamedullary glomeruli and spiral arteries (from the interlobular and arcuate). In case of disturbances in the circulatory system, ischemia develops in the area of the renal papilla, which is accompanied by the development of necrosis. This is also facilitated by the fact that the diameter of the vessels decreases towards the apex of the papilla. This leads to an increase in blood viscosity in the vessels of the renal papilla.

Pelvic-renal reflux also plays a role in the development of necrosis of the renal papillae. Their development is promoted by pelvic hypertension. As a result, sine and interstitial tissue the kidneys are infiltrated, blood circulation in the kidney is disrupted and renal ischemia develops.

Obstruction of the urinary tract can contribute to the development of necrosis of the renal papillae. In this case, urine accumulates in the pelvis, stretches it and compresses the kidney tissue. This leads to compression of the kidney vessels. Ischemia sets in and creates favorable conditions for the development of infection. In addition, as a result of obstruction, urine enters the fatty tissue, causes inflammation, sclerosis, and venous hyperemia. All this aggravates ischemia of the renal parenchyma.

Yu.A. Pytel (1972) distinguishes primary necrosis of the renal papillae and secondary necrosis, developing against the background of previous pyelonephritis.

Symptoms and diagnosis

The course of the disease can be acute or chronic.

Clinical symptoms of papillary necrosis diverse, but not specific. They are often characteristic of other diseases of the kidneys and upper urinary tract.

The most common symptoms of necrotizing papillitis are,. These symptoms cannot be considered characteristic of of this disease, but their presence makes one think about necrosis of the renal papillae. The difficulty of diagnosis is also due to the fact that necrotizing papillitis is often combined with a disease such as pyelonephritis and, being either a cause or a complication of them. Therefore, the existence of pyelonephritis or nephrolithiasis does not exclude necrosis of the renal papillae. In some cases, the presence of the patient prompts us to look for necrosis in the medulla of the kidney, since this disease is most often complicated by necrosis of the renal papillae.

The only one characteristic symptom for papillary necrosis is the discharge of necrotic masses in the urine. This sign occurs in 10.2% of patients. The released masses are gray, soft in consistency, layered in structure, and often contain lumps of lime salts. The presence of necrotic masses in the urine indicates a significant destructive process in the renal medulla, both in nature and in volume.

There is a point of view that diagnosing necrosis of the renal papillae is impossible if the above-described pathognomonic sign is absent. However, this is not the case, since there are signs that allow one to suspect the disease to a certain extent.

Often necrotizing papillitis occurs against the background of acute pyelonephritis, being its complication or cause. In this case, the symptoms of acute pyelonephritis come to the fore: stunning chills, high temperature, aching or paroxysmal pain V lumbar region, headaches, malaise, severe weakness, hectic body temperature with chills and profuse sweat.

Hematuria is one of the most common symptoms papillary necrosis. It can be either an independent symptom or occur in combination with other symptoms and is most often completely painless. In these cases, if a comprehensive examination does not reveal its cause, then dynamic observation after the patient, repeated examination allows diagnosing necrosis of the renal papillae.

In the diagnosis of the disease, in addition to laboratory research, revealing signs of the inflammatory process (, leukocyturia,), great help provide X-ray methods research. Sometimes on plain radiographs a necrotic, triangular-shaped papilla encrusted with salts is visible. Excretory urography can reveal signs of acute pyelonephritis - atony of the calyces and pelvis, their deformation. However, in initial stage On excretory urograms, fornical and papillary destructions are little noticeable. Changes occur later during the period of rejection or significant destruction of the papilla. Because of this, if necrosis of the papillae is suspected excretory urography must be repeated periodically. Retrograde pyelography undesirable as it easily leads to extravasation contrast agent with infected urine into the parenchyma through pelvic-renal refluxes and, above all, tubular and sinus. But sometimes it is shown.

A.Ya. Pytel, Yu.A. Pytel (1966) described the most characteristic radiological signs necrosis of the renal papillae:

the shadow of a triangular-shaped stone with a rarefaction zone in the center;
small shadows of calcifications in the papillary-fornical zone of the calyces;
blurred, as if corroded contours of the papilla and fornix;
unclear contours of the apex of the papilla, erosion with an increase in its size, narrowing and lengthening of the arch;
formation of the fornical-medullary canal (fistula);
ring-shaped shadow around the sequestered papilla (symptom of “papillary loop”);
formation of a canal (fistula) in the papilla;
a cavity in the center of the renal pyramid, connected to the cup through a channel (fistula);
detached papilla; formation in its place of a notch with uneven contours in the distal part of the pyramid; the presence of a filling defect in the calyx or pelvis (usually triangular in shape); with occlusion of the pelvis or necrotic papilla, calico-pyelectasia is observed;
amputation of the calyces due to edema, perifocal inflammation in the area of their necks, or due to occlusion by a rejected papilla; the contours of the cups are uneven, the papillae are deformed;
leakage of contrast agent into the renal parenchyma with total medullary necrosis ("fire flame" symptom);
multiple defects in the filling of the pelvis and calyces, resembling a tumor of the pelvis or calculus.

IN recent years In connection with the development of endoscopic technology, it has become possible to use in the diagnosis of necrosis of the renal papillae an examination of the renal pelvis, calyces, and in some patients, the fornix area using rigid ureteropyeloscopes. This makes it possible to confirm the diagnosis, since it is possible to see destruction of the papilla and hematuria from the fornix area.

Unfortunately, others modern methods diagnostics - ultrasound, CT and MRI - are not very informative in making the diagnosis of papillary necrosis. More information can be obtained using these methods about concomitant diseases(nephrolithiasis and pyelonephritis).

Differential diagnosis is carried out with (tubulomedullary dilatation, medullary hypoplasia, medulocalic dystopia and renal dysplasia), renal pelvic reflux, pyelonephritis.

Treatment

Treatment of patients with papillary necrosis should be pathogenetic. It is aimed at eliminating the cause (if it is established) that caused necrotic changes in the kidney medulla, as well as to combat urinary infection, hematuria, hyperthermia and intoxication.

If occlusion of the upper urinary tract occurs due to necrotic masses, catheterization of the ureter and renal pelvis and installation of a stent are indicated.

If this manipulation does not bring any effect, it is shown surgical treatment. Surgical treatment is also indicated for the development of acute pyelonephritis, which cannot be treated successful therapy in the next 2–3 days from the moment of occurrence. And finally, surgery is indicated for profuse hematuria, which does not stop despite hemostatic therapy.

The operation should be as organ-preserving as possible. Necrotic masses are removed and urine flow is restored by installing a stent. Necrotic masses can also be removed endoscopically. In case of profuse hematuria, the lesion is removed by resection of the kidney. In cases of total brain necrosis and acute purulent pyelonephritis(with satisfactory function of the contralateral kidney), nephrectomy is possible. In the absence of indications for surgery conservative treatment carry out as in acute pyelonephritis using the entire arsenal of modern antibacterial agents.

The prognosis for timely treatment is favorable, since epithelization occurs after the removal of necrotic masses wound surface and restoration of kidney function.

As a result of complications of certain diseases, injuries, and blood poisoning, kidney necrosis may occur. This dangerous pathology, provoking renal failure. This results in cell death renal tissue. 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 fatal outcome.

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:

Prerenal failure. As a result of circulatory disorders, the functional abilities of the kidney deteriorate. Since impaired blood flow leads to ischemia (death of a tissue area), this type of pathology develops into renal failure.
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).
Postrenal failure. Kidney function is normal. Due to damage to the 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. In women this pathology diagnosed 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. Within 3-5 days, acute renal failure develops, 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 urinary tract, stone formation. With sickle cell anemia, there are no pathological symptoms.

Cortical necrosis

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 occur 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 due to premature detachment placenta, sepsis, dehydration, shock, 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).

Main symptoms of the disease:

urine turns red or brown (due to high content blood);
pain in the lumbar region;
increased body temperature;
demotion blood pressure;
disturbance or absence of urination.

Acute tubular necrosis

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. As a result, there is serious damage renal tissue and changes in the structure of the organ, which leads to renal 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.

Complications and consequences

Complications of each type of necrosis are reduced to the development of renal failure. In this case, severe intoxication is observed, as a result of which organs of other systems are affected. According to statistics, 70−80% of patients diagnosed with kidney necrosis die from blood poisoning, heart or kidney failure. If you have symptoms of this disease, especially if you have previously been diagnosed with kidney disease, you should urgently go to the hospital for diagnosis and treatment. If treatment is not started in time, the kidneys may become so damaged that a transplant will be required or the pathology will lead to death.

Diagnostics

For correct setting Anamnesis is important for diagnosis. The doctor asks the patient about symptoms, existing kidney disease and concomitant diseases, in particular, about diabetes mellitus and the medications used. Need to take into account possible injuries or contact with toxic substances. Then a laboratory test of blood and urine is prescribed. Since all types of necrosis cannot be determined using the same method, ultrasound examination and x-ray.

If the patient has necrosis of the renal papillae, then dead papillae may be detected in the urine. The diagnosis is confirmed using radiography.
Cortical necrosis is determined by ultrasound.
Diagnosis of tubular necrosis requires maximum quantity information. A general and biochemical analysis blood and urine, ultrasound, x-ray, computed tomography.

Treatment methods

First of all, it is necessary to eliminate the causes of the disease as quickly as possible. Next, treatment is carried out depending on the type of pathology:

If necrosis of the renal papillae is diagnosed, antispasmodics are used to eliminate the cause. If the ureter is blocked, a catheter is inserted. Medicines are used to restore blood circulation, strengthen the immune system, as well as broad-spectrum antibiotics. If drug treatment does not give results, the affected kidney is removed.
In the case of cortical necrosis, first of all, the blood supply to the brain tissue of the kidney is restored. The blood is purified using a machine " artificial kidney"(hemodialysis). Antibiotics are used to suppress infection.
If the tubules are damaged, the use of drugs that can cause intoxication is discontinued. To fight the infection, antibacterial medications are prescribed, blood circulation in the organ is restored, and the body is cleansed of toxins. Apply necessary funds to relieve symptoms (nausea, vomiting).

General forecast

If treatment is started on time, the kidneys can be restored. However, according to statistics, most cases require transplantation. Dialysis is mandatory. This procedure cleanses the blood as well as the kidneys. Dialysis is mandatory for all patients with kidney failure. Unfortunately, if the hospital visit occurred during last stages development of the disease, there is a high probability of death. Therefore, if you have any symptoms indicating kidney disease, you should immediately consult a doctor.

Kidney necrosis is diagnosed during destructive processes in the tissues of the organ, which are manifested by swelling of protein molecules. Kidney destruction develops as pathological complication many diseases or due to intoxication of the body. This disease is dangerous because it can initiate kidney failure.

The kidney is a paired bean-shaped organ, the main task of which is urine formation and protecting the blood from intoxication through its filtration.

Additional functions of the kidneys are:

removal of toxins and medicines with urine;
regulation of electrolytes in the bloodstream;
control of acid-base balance;
support healthy level blood pressure;
production of biologically active substances.

The right kidney is smaller than the left, and it is susceptible various pathologies to a greater extent. The adrenal glands are located in upper area organ, their task is hormonal synthesis. The hormones produced are controlled metabolic processes in the body, affect the functioning circulatory system, internal organs, skeleton.

Impaired renal function affects general health person. One of the dangerous pathologies is necrosis. The occurrence of the disease is facilitated by atherosclerosis, thrombosis, diabetes mellitus, and the use of analgesics.

Characteristics of the pathology

With kidney necrosis, damage to cytoplasmic proteins is recorded, in which the cellular structure of the organ dies. The disease is diagnosed in people different ages, including in newborns.

To the main reasons causing disease, include:

infectious processes, sepsis;
injuries, blood loss;
placental passage during pregnancy;
kidney rejection after transplantation;
intoxication with chemical compounds;
exacerbation of cardiovascular pathologies.

Depending on the location of the lesion, cortical, tubular, and papillary types of the disease are distinguished.

Cortical

A rarely diagnosed type of necrosis, in which the outer membrane of the kidney is affected, while the inner membrane remains intact. The cause of the pathology is blockage small vessels, which nourish the cortex.

Kidney disease is manifested by the following symptoms:

reduction or absence of urination;
blood in urine;
high temperature.

In addition, changes in blood pressure, as well as pulmonary edema, are possible.

Important! Endotoxic shock promotes centralization of blood flow, its deficiency, which causes necrosis of organ tissue.

The crusted appearance is often found in infants. This is explained by placental abruption, blood poisoning, infectious processes. In women, in most cases, the disease manifests itself in postpartum period due to uterine bleeding, infectious diseases, compression of the arteries.

Papillary

Papillary necrosis is the death of the renal papilla. The functionality of the organ is impaired due to the destruction of the brain area.

By the way! In patients suffering from pyelonephritis, papillary necrosis is diagnosed in 3% of cases.

The acute form of the disease is manifested by colic, chills, and cessation of urination.

The causes of the pathology are:

dysfunction of the blood supply to the brain and renal papillae;
disruption of the outflow of urine in the pelvis;
inflammatory phenomena, purulent formations in the organ;
toxic poisoning tissue structure kidneys

The disease is more common in women.

Tubular

Tubular necrosis of the kidneys (acute tubular necrosis) is characterized by damage to the mucous membrane of the nephron tubules, which provokes renal failure.

Acute tubular necrosis occurs in two types:

Ischemic. Pathology is caused by mechanical damage, sepsis, " oxygen starvation» blood, inflammatory phenomena.
Nephrotoxic. It becomes a consequence of severe intoxication of the body.

Acute tubular necrosis develops as a result of serious damage to the tubular epithelium, accompanied by intense tissue inflammation. As a result, the kidney structure changes, initiating organ failure.

Diagnostic and treatment methods

Taking an anamnesis plays a predominant role in making a diagnosis. Samples are taken, ultrasound scans and radiography are performed. A CT scan may be needed. Each type of disease is differentiated in different ways.

The main therapeutic task is to eliminate inflammatory foci and prevent the death of the renal structure and tubules. The treatment regimen for necrosis depends on the type of disease and the factors that provoked the disease.

Therapeutic measures:

When found papillary type antispasmodics are prescribed. In case of ureteral obstruction, a catheter must be inserted. Medicines are used that restore blood supply, increase immune status, and antibiotics. In the absence of positive dynamics from drug therapy removal of the affected organ is necessary.
Acute tubular necrosis is treated antibacterial drugs regulating blood circulation in the kidney. The body is cleansed of toxic elements.
For cortical pathology, treatment is aimed at restoring blood flow in the brain part of the organ. Infectious phenomena eliminated with antibiotics.

If treatment is not timely, renal failure develops, which is accompanied by intense poisoning of the body with damage to other organs.

The operation is prescribed only in advanced cases when destruction affects the entire structure of the kidney. In case of vessel thrombosis, thrombectomy is performed.

If the disease is diagnosed on initial stage Kidney function can be restored. However, many patients are indicated regular procedure dialysis (blood purification) or organ transplantation. Recovery is based on eliminating bacterial infections and improving the reactivity of the human body.

Kidney necrosis - serious illness leading to death if left untreated. To prevent irreparable consequences, undergo regular examinations. When strange symptoms Contact your doctor immediately.

Kidney necrosis is dangerous pathological process, characterized in its course by the development of acute renal failure, when in the absence of help from doctors, failure of the organ itself and a fatal outcome for the patient cannot be ruled out.

What is kidney necrosis

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

Most common cause pathological process is a failure in blood circulation or negative influence pathogenic microflora.

Types of pathology

In practice, doctors distinguish 5 types of pathological process.

Necrosis affecting the renal papillae - necroticpapillitis– can be acute and chronic.
Canalicular appearance– in this case, the epithelium of the renal canals is damaged.
Cortical view– in this case, damage occurs 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 a previous illness.
Focal view– marked by point lesions of the glomeruli of the organ, while the kidneys themselves function normally.

Reasons

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

Regarding the root causes of the development of the tubular type of pathology, doctors name the reasons for its appearance as injuries or an inflammatory process that compresses blood vessels, thereby disrupting blood flow, poisoning with medications or toxins. If we talk about the cortical type, it is provoked by pathogenic microflora or state of shock, disrupting blood flow.

Caseous type– this is rather a consequence that shows itself to be a complication after tuberculosis or syphilis, leprosy, and the focal one is the negative effect of pathogenic microflora and a disruption 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.

Among other reasons, doctors include rejection of the patient’s implant that has not taken root. donor kidney and an inflammatory process affecting the pancreas, the bite of a snake or other poisonous reptile or insect, plus poisoning.

Diseases such as diabetes mellitus and vasospasm pose no less danger to the patient. increased viscosity blood, provoking abundant formation of blood clots and atherosclerosis, developing anemia, or infectious lesion genitourinary system.

Symptoms

If we talk about the general symptoms of the 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 indicates general intoxication of the body.

Afterwards, attacks of painful contractions develop in lumbar region back pain and cannot be relieved with simple painkillers. No less important and characteristic feature kidney damage and the development of necrosis, there is a volume of urine excreted - it decreases to pathological volumes and does not exceed more than 50 milliliters per day.

When undergoing an examination and laboratory analysis of the composition of urine, the latter will reveal increased performance leukocytes. The analysis also reveals pathogenic microflora and, in some cases, blood clots.

Diagnostics

To make a correct diagnosis, at the very beginning the specialist collects an anamnesis, namely, clarifies a number of symptoms that worry the patient and accompanying pathologies, diseases, in particular, whether he suffers diabetes mellitus whether he is taking certain medications.

Also in mandatory anamnesis is collected about the past surgical interventions and injuries, whether there is contact with poisons and toxic substances.

After collecting anamnesis, both urine and blood are collected and examined. Whenever controversial issues in the study - the specialist prescribes an ultrasound scan of the kidneys and X-ray studies. Doctors may also conduct the following tests:

If necrotizing papillitis is suspected, radiography is performed.
The cortical type of necrosis is diagnosed using an ultrasound procedure.
So the tubular type of pathological process is diagnosed based on the results laboratory tests– biochemical analysis of blood and urine, ultrasound and CT.

Treatment

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

When diagnosing necrotizing papillitis, to eliminate the root cause, doctors prescribe antispasmodics. If a blockage of the ureter is diagnosed, a catheter is installed, medications that increase blood flow and strengthen the immune system. As necessary, antibiotics are prescribed that have wide range actions. If there is no positive dynamics of treatment, the affected kidney is simply removed.
When the cortical type of necrosis develops, an emergency procedure for hardware restoration of blood flow is used. To remove negative manifestation and the consequences of intoxication - a course of antibiotics is prescribed.
When diagnosing tubular damage, medications are prescribed that cleanse the body of the effects of intoxication and poisoning, plus supplementing the course with antibacterial drugs. It is also important to restore normal blood flow and nutrition to the organ, and also prescribe compounds that relieve negative symptoms vomiting and nausea.

Consequences and complications

Consequence and negative complication The course of the pathology is the development of renal failure. In this case, the patient exhibits strong signs intoxication, damage to other organs and systems occurs.

As shown medical statistics– 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, a course is not prescribed effective therapy– over time, an organ transplant may be needed or developing pathology will cause death.

As a result of complications of certain diseases, injuries, and blood poisoning, kidney necrosis may occur. This is a dangerous pathology that provokes 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 of internal organs or the result of external influences.

Description of the pathology

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

There are the following types of necrosis:

Prerenal failure. As a result of circulatory disorders, the functional abilities of the kidney deteriorate. Since impaired blood flow leads to ischemia (death of a tissue area), this type of pathology develops into renal failure.
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).
Postrenal failure. Kidney function is normal. Due to damage to the 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)

Failure of blood circulation in the kidneys is one of the reasons for the death of organ cells.

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, and morphological changes occur in it. 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:

Blood circulation in the brain is impaired.
The renal papillae are not sufficiently supplied with blood. This occurs due to compression of the vessels by edema, inflammatory processes, vascular sclerosis (blockage of the vessel bed with cholesterol plaque), regardless of their location (in the kidney or outside it).
Due to high pressure in the 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.

The death of kidney cells can also be local, due to impaired blood circulation in certain areas of the organ.

As a result of blockage of the blood vessels through which nutrition is delivered to the kidney cortex, the outer part of the organ dies. The functioning of the kidney is impaired and failure occurs. 30% of cases of this disease occur 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 a postpartum complication. The pathology develops due to early abruption or incorrect location of the placenta, uterine bleeding, infection introduced during childbirth, blockage of the arteries with fluid from the amnion (the membrane in which the embryo is located). Tubular necrosis is damage to the renal tubules of a chemical and mechanical nature.

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

Ischemic necrosis is provoked by injuries, inflammatory processes, sepsis, shock, and low oxygen levels 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 to the renal tubules due to sloughing of the epithelium. This pathology damages the tubular cells themselves and is accompanied by an 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 (damage to the nervous system by toxins);
swelling;
weak urination;
nausea, vomiting.