renal artery embolism
Introduction
Introduction to renal artery embolism Renal artery embolism includes renal artery emboli and renal artery thrombosis. Because it is quite rare, the symptoms are not specific, so it is easy to misdiagnose or delay diagnosis. Renal artery embolism can cause hypertension and acute renal failure. Under certain conditions, the renal artery or its branches may form a local thrombus or be embolized by a circulatory embolus. If the larger artery is blocked by a thrombus or an embolus, it will cause renal ischemia and even induce renal infarction. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: acute renal failure
Cause
Cause of renal artery embolism
Spontaneous embolism (38%):
Spontaneous development: renal arteriosclerosis, aortic or renal aneurysm, renal artery fibromuscular dysplasia, renal artery inflammation (nodular polyarteritis, multiple arteritis, occlusive thromboangiitis and syphilis), blood Disease (anti-thrombin III deficiency, sickle cell disease), metabolic disease (familial hypercholesterolemia, homocystinuria).
Other factors (35%):
(1) cardiac embolism: atrial fibrillation, artificial heart valve, wall thrombus after myocardial infarction, left atrial myxoma.
(2) secondary trauma: pedicle of the kidney pedicle, aortic or renal angiography, percutaneous transluminal renal artery balloon dilatation, renal artery reconstruction, renal transplantation embolization.
Prevention
Renal artery embolism prevention
1. Control calories: The calorie intake must be balanced with the calories burned. Keep this balance within the standard weight range by properly balancing the diet and strengthening physical activity.
2. Low-fat diet: Eat less animal oil, replace it with vegetable oil, such as soybean oil, peanut oil, corn oil, etc., the dosage is 25 per person per day, less than 750 grams per month, to limit the amount of cholesterol in the food, each Every day should be less than 300 mg, egg yolk and liver, kidney and other animal visceral fat content is higher, should be eaten less.
Complication
Renal artery embolization complications Complications acute renal failure
When both sides of the kidney have an infarction, acute renal failure can result from ischemic necrosis of the kidney. The most common complication is renal parenchymal necrosis, followed by embolism often affecting other abdominal organs (such as the pancreas, gastrointestinal tract). It is formed by blood clots, hemorrhage, necrosis, ulceration, and calcification. The atheromatous plaque can form a so-called atheroma due to the collapse of the endometrial surface; after the rupture, the atherogenic material enters the bloodstream and becomes an embolus. The ulceration can cause bleeding, the surface of the ulcer is rough and easy to produce thrombus, and the thrombus formation of the wall is The stenosis of the lumen is increased and even occluded.
Symptom
Renal artery embolism symptoms common symptoms traumatic sudden high back pain high fever high blood pressure low heat renal arteriosclerosis hematuria vomiting nausea
1. Patients with acute renal infarction have previously had a history of coronary heart disease, valvular disease, arrhythmia, atrial fibrillation, and peripheral vascular disease.
2. Acute renal colic can suddenly have severe low back pain without obvious incentives. The pain is persistent, accompanied by low fever, nausea, vomiting and general malaise. Some patients have trauma history, iatrogenic renal artery operation, cocaine injection history, etc. .
3. Patients can often have high fever.
4. Hematuria: It can be gross hematuria or microscopic hematuria, which is caused by red blood cells entering the collecting system during renal infarction.
5. Hypertension: It usually occurs within a few days after the onset of illness and can return to normal after a few weeks.
Examine
Renal artery embolization
1. Urine examination: microscopic examination can find red blood cells and a small amount of protein, urine LD (lactate dehydrogenase) H1, LDH2 and alkaline phosphatase activity will increase.
2. Blood examination: Blood count can be seen in white blood cell count and neutrophil elevation, LDH (can be increased to more than 2 000 U / ml, and lasts for 14 days), aspartate aminotransferase and alkaline phosphatase increased.
3. Renal function tests: Very few patients will develop acute renal failure.
4. Urinary tract film: When calcium salt deposition occurs in the renal infarction area 3 to 4 weeks after the onset, calcification shadows appear on the plain film, and the renal shadow is reduced.
Diagnosis
Diagnosis and diagnosis of renal artery embolization
diagnosis
In patients with risk factors for renal artery thrombosis or embolism, suspected symptoms and signs should be suspected for further examination, although serum enzymology (serum aspartate aminotransferase GOT, LDH and serum alkaline phosphatase AKP) test Diagnosis is helpful, but not specific, and renal imaging is still needed for diagnosis, especially selective renal angiography.
Differential diagnosis
1. Renal ureteral calculi: In the process of stone discharge, there may be severe colic attacks like renal artery embolization, or microscopic or gross hematuria. B-ultrasound can also show the location of stones and renal ureteral hydrops. Case.
2. Acute appendicitis: mainly manifested as metastatic right lower abdominal pain symptoms, sometimes fever, nausea, vomiting, tenderness and rebound tenderness in the right lower abdomen, patients generally have no hematuria and sneezing pain in the kidney area.
3. Spontaneous renal rupture: can also be characterized by sudden lumbar pain, severe pain, may be accompanied by nausea, vomiting, the affected side of the waist can touch the mass, muscle tension, may have tenderness, shock can also occur with severe bleeding Symptoms, microscopic hematuria and even gross hematuria can occur, mainly through B-ultrasound, CT to determine the diagnosis.
