From Big Medical Encyclopedia

RENAL NIPPLES NECROSIS (synonym: papillary necrosis, necrotic papillitis, necrosis of marrow of a kidney) — an ischemic heart attack of marrow of a kidney with purulent fusion, rejection of nekrotizirovanny fabric and dysfunction of body. For the first time this disease was described by N. Friedreich in 1877. The circulatory disturbance in marrow of a kidney and a renal nipple owing to inflammatory exchange and vascular changes of a kidney, disturbance of outflow of urine with developing of intrapelvic hypertensia and lokhanochno-renal refluxes, pyoinflammatory process in marrow of a kidney, change of composition of blood is the cornerstone of necrotic changes. According to it allocate infectious, angiopatichesky and vazokompressionny factors of a pathogeny of P. of page of N. Usually the combined influence of these factors takes place. Pyelonephritis (see) — the most frequent inf. the disease which is combined with a necrosis of renal nipples also in most cases is one of its main reasons. The originality of anatomo-physiological features of marrow of a kidney in the conditions of ischemia (e.g., reduction of diameter of vessels to top of a nipple, increase in viscosity of blood and delay of a blood-groove) contributes to development of necrotic changes of renal nipples.

According to infectious and angiopatichesky factors it is accepted to distinguish primary and secondary P. of page of N. At primary P. the page of N which resulted from disturbance of blood circulation purulent process is a complication; at secondary — necrotic changes are a complication of pyelonephritis. Necrotic processes in marrow of a kidney can be a complication of a diabetes mellitus. However of page of N the diabetes mellitus occurs among sick P. no more than in 15% of cases.

At P. the page of N at 40% of patients notes education urinary stones (see). It is caused by the fact that necrotic masses is easily inlaid with concretion.

On P.'s current of page of N happens acute and chronic. The acute current is followed by the expressed intoxication, high fever. As P. is often combined by page of N with a nephrolithiasis and pyelonephritis, on a wedge, to manifestations it is similar to these diseases. In addition to back pains, it is frequent in the form of an attack of renal colic (see. Nephrolithiasis ), the total hamaturia is observed (see. Hamaturia ). The only pathognomonic symptom of P. of page of N — an otkhozhdeniye of necrotic masses with urine that is observed only in 10% of cases. The bilateral P. of page of N which is combined with pyelonephritis quickly leads to emergence renal failure (see).

Less rough manifestations in the form of incidentally recurrent gross hematuria are characteristic of chronically proceeding P. of page of N, bacteriurias (see), leukocyturias (see).

In P.'s diagnosis by the village of N the wedge, symptomatology of a disease (a hamaturia, renal colic, fever) and data a lab matter. researches of urine. At microscopic examination in urine find necrotic masses, in to-rykh contours of a stroma of a renal nipple are sometimes visible.

the Retrograde piyelogramma at a necrosis of renal nipples: the cavities in cones of kidney (are specified by shooters) formed as a result of a papillary necrosis.

The main diagnostic method of P. of page of N is rentgenol, the research. In a survey picture of an abdominal cavity the shadows of calcification caused by calcificats of necrotic mass of a renal nipple and also a shadow of a concrement of triangular shape can decide on sites of depression in the center. At excretory urography (see) and retrograde piyelografiya (see) which need to be made in different projections, find two types P. of page of N (fornikalny and papillary) with characteristic rentgenol, signs — an illegibility of contours of a nipple and a forniks, erosive changes, formation of fistulas with zateky in them a contrast agent, amputation of a cup, rejection of a nipple, and also formation of the cavities which are reported with cups (fig). The renal angiography, an isotope renografiya, a stsintigrafiya, ultrasonic scanning of independent diagnostic value have no.

Differential diagnosis carry out with a nephrophthisis (see Tuberculosis extra pulmonary) and tumors of a kidney (see).

Treatment Item of page of N conservative and operational. Conservative treatment of patients with an acute current of P. of page of N (catheterization of an ureter for recovery of a passage of urine, antibacterial and haemo static therapy, etc.) generally symptomatic; to its thicket carry out not so much concerning P. page of N how many because of his complications. In the absence of effect of conservative treatment of acute P. of page of N within a day from the beginning of a disease an operative measure is shown. Considering the frequency of bilateral defeat, apply generally organ-preserving operations — a nephropyelostomy or a nephrectomy. Nephrectomy (see) make only at a unilateral total papillary necrosis with irreversible pyoinflammatory changes.

Treatment of patients hron. To the item of page of N it is directed to improvement of blood circulation of a kidney; appoint heparin, Venorutonum, and also saluretics (furosemide), in the presence of pyoinflammatory process — antibacterial drugs.

Forecast in many respects the wedge, manifestations depends on weight. Even at timely diagnosis and therapy the lethality at an acute current of P. of page of N makes 10% (apprx. 50% earlier).

Prevention consists in the basic in fight against pyoinflammatory diseases of uric ways.

Bibliography: Murvanidze D. D. About features of clinic and a current of a necrosis of renal nipples at children, Tbilisi, 1973; Pytel Yu. A. A necrosis of renal nipples, in book: Pytel A. Ya., etc. Izbr. heads nefrol, and Urals., p. 2, page 165, L., 1970; Hultengren N. Renal papillary necrosis, Acta chir, scand., suppl. No. 277, 1961; Jones L. W. a. Morrow J. W. Renal papillary necrosis, management by ureteral catheter drainage, J. Urol. (Baltimore), v. 106, p. 467, 1971; Lindvall N. Renal papillary necrosis, Acta radiol. (Stockh.), suppl. jvft 192, 1960; L u d v i k W. Die Papillennek-rose, Urologe, Bd 7, S. 36, 1968; R F of e-nyi-V£mos. Balogh F. Pyelonephritis, p. 129, Budapest, 1979; Tauber t W.

u. Prager W. Zur Genese von Nierenpapillennekrosen, Radiobiol. Radiother. (Berl.), Bd 11, S. 381, 1*970.

Yu. A. Pytel.