The Nierenrindennekrose represents the destruction of renal cortical tissue by damaging the renal arterioles and leads to chronic kidney disease. This rare disease typically occurs in newborns, pregnant women and postpartum women with sepsis or pregnancy complications. As Symptoms gross hematuria, flank pain, decreased urine output, fever and symptoms of uremia occur. The symptoms of the underlying disease may outweigh. The diagnosis is made by MRI, CT, isotope analysis or kidney biopsy. The mortality rate within the first year is> 20%. Treatment depends on the underlying disease and are the preservation of renal function.
When Nierenrindennekrose that may be patchy or diffuse, the bilateral damage to the renal arterioles to destruction and calcification of renal cortical tissue and acute renal failure results. The adrenocortical tissue eventually calcified. Juxtamedullärer cortex, medulla, and the region immediately below the capsule spared.
The Nierenrindennekrose represents the destruction of renal cortical tissue by damaging the renal arterioles and leads to chronic kidney disease. This rare disease typically occurs in newborns, pregnant women and postpartum women with sepsis or pregnancy complications. As Symptoms gross hematuria, flank pain, decreased urine output, fever and symptoms of uremia occur. The symptoms of the underlying disease may outweigh. The diagnosis is made by MRI, CT, isotope analysis or kidney biopsy. The mortality rate within the first year is> 20%. Treatment depends on the underlying disease and are the preservation of renal function. When Nierenrindennekrose that may be patchy or diffuse, the bilateral damage to the renal arterioles to destruction and calcification of renal cortical tissue and acute renal failure results. The adrenocortical tissue eventually calcified. Juxtamedullärer cortex, medulla, and the region immediately below the capsule spared. Etiology The injury usually results from a decrease in renal artery flow due to vasospasm, microvascular damage or intravascular coagulation. In about 10% of cases, infants and children are affected. Pregnancy complications increase the risk of injury in newborns and women as well as sepsis. Other reasons (. Eg disseminated intravascular coagulation [DIC]) are less common (see Table: Causes of Nierenrindennekrose). Causes of Nierenrindennekrose patients causes newborns placental separation (caused about 50% of cases) Congenital heart defects (severe) dehydration fetomaternal transfusion Hemolytic anemia Perinatal asphyxia renal vein thrombosis Sepsis Children dehydration hemolytic uremic syndrome sepsis shock pregnant women and women after childbirth complications during pregnancy (cause> 50% of cases): Placental abruption, amniotic fluid embolism, fetal death, placenta previa, preeclampsia, puerperal sepsis, uterine bleeding sepsis (caused approximately 30%) Other burns Disseminated intravascular coagulation medication (eg. B. NSAIDs) Hyper Acute rejection after kidney Nephrotoxic incompatible blood transfusion contrast pancreatitis poisoning (eg., Phosphorus, arsenic) sepsis snakebite injury symptoms and complaints gross hematuria, flank pain, occasionally decreased urine output or acute anuria occur. Usually there is fever, and it develops a chronic kidney disease with hypertension. These symptoms are however often masked by the symptoms of the underlying disorder. Diagnostic Imaging, usually with CT angiography The diagnosis is based on the typical symptoms in patients with a possible causal relationship. Imaging methods can confirm the diagnosis occasionally. CT angiography is usually preferred, despite the risks because of iodinated contrast agent. Because of the risk of nephrogenic systemic fibrosis, magnetic resonance angiography is with the contrast agent gadolinium in these patients who have severe kidney dysfunction usually not recommended. An alternative is the Isotopennephrographie is with diethylenetriamine. This shows enlarged nichtobstruierte kidneys with little or no blood flow. The kidney biopsy is only appropriate if the diagnosis is unclear and there are no contraindications. It leads to the definitive diagnosis and provides prognostic information. Urinalysis, complete blood count, liver function tests and Serumelektrolyt- and kidney function tests are performed routinely. These tests often confirm the renal dysfunction (eg. As increased creatinine and urea and hyperkalemia) and indicate a possible cause. There may be severe electrolyte abnormalities, depending on the cause (eg. As hyperkalemia, hyperphosphatemia, hypocalcemia). The blood count often shows a leukocytosis (even if sepsis is not the cause) and can reveal anemia and thrombocytopenia when hemolysis, DIC or sepsis present. At relatively hypovolemic status (eg., Septic shock, postpartum hemorrhage) may be elevated transaminases. If DIC is suspected, coagulation tests are performed. This can uncover low fibrinogen levels, increased Fibrindegradationsprodukte and increased INR. In the urine, there are typically proteinuria and hematuria. Prognosis The prognosis of Nierenrindennekrose was bad in the past, with mortality rates of> 50% in the first year. More recently, can be about 20% with aggressive supportive therapy, the 1-year mortality and up to 20% of survivors renal function can be restored. The therapy treatment depends on the infectious disease, and is in the preservation of renal function (z. B. with an early dialysis). Key points A Nierenrindennekrose is rare, typically occurs in newborns, pregnant women and postpartum women with sepsis or pregnancy complications. If you suspect the diagnosis in patients at risk, the typical symptoms develop (eg. As gross hematuria, flank pain, decreased urine output, fever, high blood pressure). Confirm the diagnosis with renal vascular imaging, usually CT angiography. Treat the underlying disease.