Kidney Infarction - Dangerous or Curable?
What is a kidney attack?
The destruction of kidney tissue is called a kidney infarction. Kidney infarction occurs when a blood clot blocks a blood vessel in the kidney and the kidney can no longer be supplied with sufficient oxygen as a result. If the circulatory disorder is not corrected immediately, the kidney tissue perishes. A key symptom is colicky flank pain. Depending on the extent of the infarction, a distinction is made between a complete kidney infarction and a partial kidney infarction. Kidney infarctions are rare these days due to good preventative measures. If a kidney infarction is noticed in good time, it can be treated well and serious consequences can be avoided.
Causes of Kidney Infarction
Embolism and thrombosis are the main causes of kidney infarction. Most often, embolisms trigger kidney infarctions. An embolus (Vascular plug) mostly from the heart and gets stuck in a small renal artery and clogs the vessel.
There are several ways in which an embolus can develop. In atrial fibrillation, it can form in the left atrium of the heart. In the case of bacterial inflammation of the lining of the heart (Endocarditis) Deposits on the heart wall can peel off and form clots, especially in the left ventricle. In addition to the heart, the main artery (aorta) Be the origin of the embolus. In the case of the widespread disease arteriosclerosis (Vascular calcification) vascular plasties can peel off and occlude the kidney vessels. Renal infarction can also be caused by renal artery thrombosis. Risk factors for thrombosis are changes in the vessel walls, blood flow, and blood composition. The blood clot that clogs the renal artery in renal artery thrombosis is formed locally and can trigger a kidney infarction via the thrombosis.
For more information, see: Dangers of an embolism - you should know that!
Symptoms of a kidney infarction
The symptoms of a kidney infarction can be very different. The main symptom of a kidney infarction is sudden, severe pain in the flank. The pain is often colic-like, which means that the pain occurs at intervals. The pain comes very quickly and very strongly, disappears suddenly and comes back violently. The pain can be accompanied by sweats, nausea, and circulatory problems. In addition to nausea, vomiting and severe abdominal pain can also occur, especially when larger areas of the kidney are affected. Macro hematuria can develop in the following days. This means that the butt can be seen in the urine. If the kidney infarction goes unnoticed and untreated, kidney function may deteriorate. Symptoms of this are abnormal urine that is darker, lighter in color, or decreasing in amount. It can happen that you have to go to the toilet very often and you don't pass much water. You may experience night urination and blood in the urine. However, 25% of all kidney infarctions remain without any symptoms and are therefore difficult to diagnose early on.
What can be signs of a kidney attack?
The severe flank pain, which often occurs like a colic, is an important symptom of a kidney infarction. Nausea, abdominal pain, and difficulty urinating can also indicate kidney disease and should be examined carefully. Blood in the urine is a serious symptom and should always be checked by a doctor.
Diagnosis of kidney infarction
The suspicion of a kidney infarction arises from the symptoms. Admission to the clinic must be carried out as quickly as possible in order to prevent consequences such as kidney failure. A conversation followed by a physical examination is carried out to establish the diagnosis. Tapping the kidneys as part of the physical examination is usually found painful by those affected. Blood is also drawn in order to check kidney function using laboratory parameters and to detect kidney damage. An ultrasound scan quickly provides a good view of the renal vessels and enables up to 97% of renal artery pathologies to be determined. Angiography, which uses contrast media to visualize blood flow to the kidneys, can be used to confirm the diagnosis. Other imaging measures may be necessary to diagnose a "kidney infarction", such as an MRI of the kidney or a kidney scintigraphy.
Ultrasound examination for a kidney infarction
The ultrasound examination is a quick, gentle method to get an overview of the blood flow to the kidneys. In most cases, the arteries can be easily visualized and strong changes in the renal arteries are detected with the ultrasound device in up to 97% of cases. Modern ultrasound devices can use a Doppler signal to check how well the vessels shown are supplied with blood.
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Angiography for a kidney infarction
Angiography is an X-ray examination of blood vessels in which a catheter is used to inject contrast medium into the vessels to be examined. So the arteries can be shown very well. Renal artery angiography can be used to confirm the diagnosis “kidney infarction”.
Also read: Angiography - Procedure and Complications
MRI for a kidney infarction
The MRI (Magnetic resonance imaging) is an exam that can be used to visualize the kidneys. This examination can be carried out with a contrast medium and is particularly suitable for clarifying unclear spatial claims. An MRI can be used in the practice to clarify a narrowing of the kidney arteries. In most cases, a simple ultrasound scan is enough to diagnose a "kidney infarction".
For more information, see: MRI procedures and risks
Treatment of kidney infarction
Kidney infarction should be treated as soon as possible to avoid the consequences of insufficient oxygen supply to the kidney. As an immediate measure, those affected with an acute kidney infarction are given heparin (5,000 to 10,000 IU, international units). This is an anti-coagulant used to prevent further blood clots from forming and to dissolve existing ones. If both kidneys are affected, dialysis may be necessary, in which the kidney function is replaced with a device. If the clot cannot be dissolved with Herapin, surgery or lysis therapy is an option. The harmful embolus or thrombus can be surgically removed. As part of a lysis therapy, a catheter is pushed into the kidney and a drug is administered over it, which finally breaks down the clot. In lysis therapy, the enzyme urokinase or the active ingredient rtPA (Recombinant Tissue Plasminogen Activator), i.e. substances that naturally dissolve the blood clot.
You might also be interested in: Dialysis - Procedure and Complications
Proper nutrition after a kidney attack
After a kidney infarction, the diet depends on the underlying disease and the consequences of the infarction. If acute kidney failure occurs, hydration is an important aspect and should be discussed with the attending physician. The diet should specifically lower the level of urinary substances in the blood, normalize blood pressure and flush out water retention. Too much protein in the diet can put stress on the kidneys, while avoiding protein slows the progression of kidney failure. Depending on the severity of the kidney weakness, the protein content in the food should be adjusted; overall, the diet should always be low in protein. It should also be discussed with the doctor how much salt can be consumed. Too much salt can negatively affect blood pressure, but not using it can actually make kidney function worse. It is therefore important to adjust the salt intake to the individual situation. After a kidney infarction, a low-protein diet is generally positive for the prognosis. The consequences of a kidney infarction can vary, so the diet should be discussed individually with the attending physician.
For more information, see: Kidney Disease Diet
The possible complications of a kidney infarction
The duration and extent of the kidney infarction largely determine the course of the disease. If the kidney infarction affects a larger area of the kidney, acute kidney failure can result. Acute kidney failure is characterized by the fact that the kidney cannot do its job properly. Substances from the blood that are passed through the urine, normally excreted in the urine by the kidneys, remain in the blood. This has a negative effect on the body's electrolyte and acid-base balance. Life-threatening uremia (urinary poisoning) can develop if the urine builds up in the urinary tract. In addition, other symptoms can occur with kidney failure, such as nausea, vomiting, unbearable itching and inflammation of the stomach and intestinal mucosa. Pulmonary edema, dyspnoea and cyanosis (blue discoloration of the skin and mucous membranes) can occur. A long-term increased urea content in the blood can lead to pathological changes in the brain.
More about this topic can be found: Acute kidney failure
If the kidney infarction is caused by an arterial vascular occlusion, the kidney failure can become chronic and turn into kidney failure (kidney weakness). Renal insufficiency often requires dialysis.
For more information, see: Renal failure
The long-term consequences of a kidney attack
The long-term consequences are heavily dependent on the extent and duration of the reduced blood flow to the kidneys. In the case of a mild kidney infarction that is recognized and hindered early on, extensive kidney recovery can be expected. If the infarct is pronounced and lasts longer, kidney failure can result. In chronic kidney failure, the kidneys can even secrete protein and blood. Water retention can occur and diseases of the lower urinary tract develop. In the advanced stages of chronic kidney failure, pronounced symptoms can occur, which are associated with poor performance, vomiting, nausea, excessive water retention and skin changes. A kidney transplant is necessary for end-stage kidney failure.
Read more about: Stages of kidney weakness up to kidney transplant
Duration and prognosis of a kidney infarction
The course of the disease and the prognosis for a kidney infarction are determined by individual circumstances, such as previous illnesses and causes of the infarction, the affected kidney area and the duration of the reduced blood flow to the kidney. The kidney may recover almost completely or suffer from kidney failure that requires dialysis. The prognosis is therefore very different from person to person. If an arterial occlusion is responsible for the kidney infarction, the prognosis is not particularly good.
Also read: Life expectancy with kidney failure