Kidney heart attack
- Kidney heart attack reasons
- Kidney heart attack symptoms
- Treatment of a heart attack of a kidney
Kidney heart attack – very rare urological disease which is in death of the site of renal fabric that is caused by the arterial occlusion bearing blood to the kidney. Developing of a heart attack requires the complete and single-step cessation of a blood-groove.
Kidney heart attack reasons:
Obstruction of a renal artery arises seldom and in most cases because in an artery settles the lump which was in a blood-groove (embolus). The embolus represents a clot (blood clot) which is usually formed in heart or at a rupture of a cholesteric plaque (atheroma) in an aorta. The kidney heart attack can also be a consequence of formation of a clot directly in a renal artery (acute thrombosis) because of damage of its wall. Damage sometimes arises at surgery, during an angiography or angioplasty. Blood clots can form at heavy atherosclerosis, arteritis (an inflammation of arteries), drepanocytic anemia or at a rupture of aneurism (protrusion) in a renal wall. The cover anguish (acute stratification) of a renal artery blocks a blood stream in an artery or causes its gap. Atherosclerosis and a fibromyshechny dysplasia (anomaly of development of connecting fabric of a wall of an artery) can be the reasons of a heart attack.
The kidney heart attack sometimes is caused purposely (a medical heart attack) at treatment of a tumor of a kidney, massive loss of protein with urine (proteinuria) or at the heavy, not giving in to treatment renal hemorrhage. At the same time blood supply of a kidney is blocked, carrying out a catheter to an artery which supplies a kidney with blood.
Kidney heart attack symptoms:
Symptoms of a heart attack of a kidney depend on defeat volume. At a small heart attack symptoms can be absent. Larger heart attack of a kidney is shown by sharp pains in lumbar area and blood impurity in urine, decrease in a diuresis is possible. Within a resorptive syndrome subfebrile condition which is usually observed for the 2-3rd day is natural. Also arterial hypertension owing to ischemia of fabrics, perifocal in relation to a zone of a necrosis, can develop.
As the heart attack of a kidney is carried to rare diseases with extremely nonspecific symptoms, detailed collecting the anamnesis has paramount value. It is necessary to ask very carefully the patient on all his associated diseases, on drugs which he accepts. To pay attention to some characteristic details. Sharp pains in lumbar area through small time after recovery of a sinoatrial rate at the patient with a ciliary arrhythmia can be caused by a kidney heart attack, especially if antiarrhytmic therapy was not preceded by long reception of anticoagulants. The same can be told also about patients with mitral insufficiency of which blinking or an atrial flutter is characteristic. The infectious endocarditis of the left departments of heart naturally gives embolisms on a big circle.
Recently persons with narcotic dependence on opiates which enter intravenously therefore they develop a specific endocarditis even more often get to hospitals. Defeat of the tricuspid valve is more characteristic of an endocarditis of addicts, but in the conditions of reduced immunity process can extend also to other valves. Heavy atherosclerosis often is complicated by fibrinferments. When collecting the anamnesis at such patient special value has the fact of irregular reception of anticoagulants or antiagregant as breaks in their reception can provoke thrombosis. The same can be told also about the persons who underwent artery operations, in this case renal.
By physical methods it is possible to reveal morbidity in projections of the affected kidney, a positive symptom of effleurage, visible impurity of blood in urine, decrease in a diuresis, fervescence.
Laboratory diagnosis of a heart attack of a kidney.
In the general analysis of urine the proteinuria and a hamaturia which can be any degree of manifestation - from slight increase of "not changed" erythrocytes to profuse bleeding is characteristic.
In the general blood test within 2-3 days the moderate leukocytosis is characteristic.
By biochemical methods it is possible to reveal increase in concentration of S-reactive protein, increase in level of a lactate dehydrogenase (LDG) in blood serum and urine (the last indicator is specific to a kidney heart attack).
The hamaturia of not clear etiology is the indication to performance of a tsistoskopiya. Allocation by the painted urine blood allows to determine the party of defeat by one of ureters, and also to unambiguously exclude a glomerulonephritis.
Koagulogramma is necessary in the shortest possible time for hemocoagulation assessment. Without koagulogramma purpose of anticoagulants or styptic drugs is extremely undesirable.
Tool diagnosis of a heart attack of a kidney.
Ultrasonography of kidneys with doppler sonography - inspection of basic importance mainly because of its comparative availability to most urological clinics in the round-the-clock mode. It allows to estimate in the noninvasive way a condition of kidneys and the main renal vessels.
It is possible to confirm the diagnosis of a heart attack of a kidney by means of KT or MPT with administration of the corresponding contrast mediums. At the same time reveal the wedge-shaped site of a parenchyma which is not accumulating contrast.
Angiography - "the gold standard" of diagnosis of damages of renal arteries. However the value of computer and angiographic techniques is strongly limited to impossibility of their real execution in the round-the-clock mode. Therefore in the majority of observations manage doppler sonography.
Differential diagnosis of a heart attack of a kidney.
Differential diagnosis of a heart attack of a kidney is difficult. First of all it is necessary to exclude renal colic. And lack of stones does not exclude it. Renal colic and owing to a clot otkhozhdeniye is quite possible. The most important argument against renal colic lack of expansion of pyelocaliceal system that testifies to safety of a passage of urine on ureters. The second for the importance and frequency the diagnosis for discussion - stratification of an aortic aneurysm. At this disease the megalgia, an acute disorder of blood supply of kidneys, a hamaturia, etc. is natural extremely. Aortic aneurysms in the majority of observations diagnose for patients of advanced age with the expressed widespread atherosclerosis and high arterial pressure; are followed extremely by megalgias. Thus, the diagnosis of a heart attack of a kidney costs on the last place as the diagnosis of an exception as its probability is extremely small without characteristic cardiovascular anamnesis.
Treatment of a heart attack of a kidney:
Usually treatment consists in purpose of anticoagulative means which have to prevent formation of new trobm and repeated blocking of a renal artery. Drugs which dissolve already formed clots (trombolitik), - newer remedy and, perhaps, more effective, than others. They improve function of kidneys only when the artery is completely not blocked or when blood clots manage to be dissolved within 1,5-3 hours, that is for that time during which tissue of a kidney can remain viable for lack of blood supply.
To eliminate obstruction, the doctor enters a catheter with the inflated cylinder on the end into a renal artery through the femoral artery passing in area of a groin. Then the cylinder is inflated that leads to opening of a gleam of the corked vessel. This procedure is called transdermal transluminal angioplasty.
What has to be optimum treatment of a heart attack of a kidney, not clearly, but medicamentous therapy is more preferable. Though by surgery it is possible to eliminate obstruction of blood vessels, it is followed by high probability of complications and death. Moreover, operation improves work of kidneys no more effectively, than anticoagulative means or thrombolytic therapy. Surgery is more preferable only in that case when it can be spent within 2-3 hours after the clot in a renal artery was formed owing to an injury (traumatic thrombosis of a renal artery).
Though as a result of treatment functioning of kidneys can improve, usually it is not recovered completely.