Diseases

Renal infarction - symptoms, causes and therapy

Renal infarction - symptoms, causes and therapy



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Infarction of the kidney

If the kidney tissue is not adequately cared for due to a circulatory disorder, a kidney infarction threatens. Symptoms do not always occur, so that even minor and incomplete infarcts remain undetected. However, if pain and other complaints arise from an acute infarction of the kidney, a quick diagnosis and appropriate therapy with anticoagulants are the most important measures to maintain kidney function. Failure to do so may result in kidney failure. This may result in a lifelong required dialysis treatment.

A brief overview

In the event of a kidney infarction, there is a risk that the kidney tissue will die irretrievably and the associated loss of kidney function will permanently burden the person concerned. The following overview briefly summarizes the most important facts about this kidney disease.

  • definition: A kidney infarction refers to a lack of blood flow to the kidney tissue, mostly due to vascular blockage, which can lead to partial or complete destruction of the organ. Renal arteries are most often affected, and less often changes in the renal veins cause the problems.
  • Symptoms: Smaller heart attacks are mostly symptom-free, while in severe cases severe flank pain, abdominal pain and blood in the urine often occur.
  • causes: In many cases, embolic occlusion of one or more renal arteries is the cause. It is less often a thrombosis or a narrowing of the vessels in a renal vein. Previous diseases of the cardiovascular system can play a role in the development, as can high blood pressure and diabetes mellitus.
  • diagnosis: A quick diagnosis is supported by a specialist examination with ultrasound and evaluations of blood and urine samples. A radiological examination of the kidney vessels (angiography) may also be necessary.
  • treatment: In the first place is the dissolution of the vascular graft by means of drug therapy and less often by surgery. Pain relievers are used in symptomatic treatment. Prophylactic measures represent further therapeutic approaches.
  • Naturopathic treatment: Kidney ailments can be prevented and their causes and symptoms can be counteracted in a natural way through nutrition and various medicinal plant applications (juniper and garlic).

Definition

If kidney tissue (kidney parenchyma) dies due to insufficient blood circulation and oxygen supply, one speaks of a kidney infarction. This can be a complete infarction or a so-called sub-infarction that affects only one or more parts of the parenchyma, but not the whole kidney.

In the event of a complete infarction, there is an acute risk that kidney failure will occur due to relatively quickly occurring necrosis (tissue death). This is particularly dangerous if both kidneys are affected. In the event of an incomplete infarct, in which the vessels are only partially closed or neighboring blood streams can maintain the supply functions, severe functional damage to the kidney can still be prevented in many cases.

In the narrower sense, a kidney infarction describes a partial or complete arterial occlusion. This is also referred to as ischemia or ischemic kidney infarction. In a broader sense, blockages in the renal veins (for example, renal vein thrombosis) can also lead to a so-called hemorrhagic renal infarction.

Symptoms

The extent of the symptoms of a kidney infarction varies greatly depending on the size of the underserved or dead area and ranges from complete absence of symptoms to severe impairments. An acute infarction mainly causes mild to severe flank pain, which is sometimes misinterpreted as renal colic. With pronounced infarctions, acute and severe abdominal pain (abdomen) can also occur. Fever can accompany the symptoms.

In more severe courses, there is also nausea and vomiting, as well as visible admixtures of blood in the urine. It is also possible to restrict kidney function with reduced urine output (oliguria and anuria). In rare cases, the disease can lead to kidney failure.

Causes

The main cause of an ischemic kidney infarction is the occlusion of one or more (usually smaller) renal arteries, which is caused by a blood clot. The blood clot (embolus) often comes from the heart and is transported to the kidney vessels (renal embolism). But an abdominal injury or arteriosclerosis can also be the cause of an embolism or a local occlusion (thrombosis) in a renal artery.

A hemorrhagic renal infarction, in which there is a occlusion in a renal vein, is usually the result of circulatory shock and right heart failure.

Risk factors

Many sufferers already suffer from cardiovascular complaints before a kidney infarction. Favorable pre-existing diseases in this context include various heart diseases, heart attacks and vascular diseases (vasculitis, arteriosclerosis). Diabetes mellitus (diabetic nephropathy) and high blood pressure, among other diseases, can also have a negative effect on the kidneys.

Diagnosis

Smaller heart attacks usually go undetected due to the lack of symptoms. However, if there are severe symptoms that indicate an acute renal infarction, a quick diagnosis is of crucial importance. In this case, those affected should be taken to a hospital with specialist medical expertise as quickly as possible due to the risk of relatively rapid kidney failure (within two hours).

Based on the first signs, there is usually a detailed patient survey (anamnesis), which also takes into account relevant previous illnesses. During the subsequent physical examination, it can be tested whether tapping in the kidney region can increase existing flank pain. The pulse is also measured and attention is paid to symptoms on the skin which indicate that there are circulatory disorders.

Blood and urine samples are taken and examined in the laboratory for certain parameters. If there is an infarction, an increased number of white blood cells (leukocytosis) and an increased detection of lactate dehydrogenase (LDH) in the blood are typically detected. However, a high serum creatinine value and an increased urea level in the blood also provide evidence of a renal dysfunction. Either the smallest amount of blood (microhematuria) or already visible blood admixtures (macrohematuria) can be detected in the urine.

By means of a simple ultrasound examination and the use of Doppler sonography, the kidney vessels and the corresponding blood flow situation can be made clearly visible. If these tests are not sufficient, angiography can also be performed. By using contrast media, this radiological examination can examine the blood vessels and reliably diagnose constipation or other pathological changes.

Of particular importance is the exclusion of (kidney) diseases with similar symptoms, such as a kidney tumor or kidney inflammation.

Treatment

In lighter cases, a kidney infarction heals on its own and may only be discovered accidentally as scarring of the affected area in later examinations. However, if an acute renal infarction is diagnosed, haste is advised and the first priority is the administration of anticoagulants (e.g. heparin), the so-called anticoagulation. Blood pressure regulation is also important. In the event of severe vascular blockage, lysis therapy can also help to dissolve the vascular graft. Surgery (embolectomy or thrombectomy) is very rarely performed.

Conventionally, symptom-relieving medication is treated with painkillers and antibiotics. The latter is said to prevent a possible kidney abscess by bacterial colonization of the dead kidney area.

Further therapy depends on the underlying diseases, especially the cardiovascular system, and should also include prophylactic measures to prevent calcification of the arteries.

Naturopathic treatment

In the event of a recognized kidney infarction, alternative therapies can provide relief and improved blood flow to those affected by permanent dietary measures. The diet should be switched to a potassium-rich and low-sodium diet with lots of whole grains as well as vegetable and fruit juices. Salt should be avoided if possible and two to three days of raw food should be introduced.

A Sebastian Kneipp cure with juniper (Juniperus communis) is also recommended, in which a daily increasing amount of juniper berries should first be chewed for kidney detoxification and blood purification. After a while, the amount is reduced again. In addition to the general purifying, blood cleansing and circulation-promoting effects, irritation of the kidney tissue can also occur, which is why specialist advice should be sought before any self-treatment.

As another well-known remedy from naturopathy, garlic can be used to prevent vascular calcification. (jvs, cs)

For further reading:
Kidney problems - causes and countermeasures

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dr. rer. nat. Corinna Schultheis

Swell:

  • Herold, Gerd: Internal Medicine 2019, self-published, 2018
  • Urologielehrbuch.de: renal artery embolism - renal infarction (accessed June 24, 2019), urologielehrbuch.de
  • UpToDate, Inc .: Renal infarction (accessed: June 24, 2019), uptodate.com
  • Bourgault, Marie / Grimbert, Philippe / Verret, Catherine / and others: Acute Renal Infarction: A Case Series, Clinical Journal of the American Society of Nephrology, Vol. 8, Issue 3, 2013, https://doi.org/10.2215/ CJN.05570612, CJASN
  • Merck & Co., Inc .: Renal artery stenosis and renal artery occlusion (accessed: June 24, 2019), msdmanuals.com
  • Keller, Christine / Geberth, Steffen: Practice of Nephrology, Springer, 3rd edition, 2010

ICD codes for this disease: N28ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.


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