A disease characterized by the destruction of kidney tissue is called necrosis. characteristic feature emerging dead cells in the organ is its swelling due to the decomposition of proteins. Necrosis of the kidney occurs in the form of complications after diseases, poisoning of the body various substances, injury.

The kidneys perform a huge number of important functions in the body, so any damage to them affects its work. The kidney is surrounded by adipose tissue, under which there is a muscle capsule associated with common system kidneys - parenchyma. The outer layer of the kidney is cortical, the inner medulla. The parenchyma is an interweaving of a million tubules and glomeruli, its medulla forms pyramids (up to 12 pieces). At the top of the pyramid is the papilla, which opens into the renal calyx. The collection of cups form the pelvis. And from the pelvis through the urethra, urine enters the bladder and is excreted.

5 main types of kidney damage

Kidney damage can be of several types, depending on the affected area:

1. Necrotizing papillitis (necrosis of the renal papillae).
2. tubular or tubular.
3. Necrosis of the cortical substance of the kidneys (cortical).
4. Cheesy.
5. Focal.

Let's take a closer look at each type.

Papillary

Necrosis of the renal papillae develops as a complication against the background of diabetes mellitus, pyelonephritis, etc. It is extremely rare to diagnose a primary disease.

The disease occurs for the following reasons:

1. Violations of blood circulation in the vessels of the medulla.
2. Violation of the blood flow of the renal papilla, as a result of compression on the vessels due to tissue edema.
3. Violations of the function of urination, resulting in stagnant processes.
4. Infectious and purulent processes.
5. Toxic damage.

Papillary necrosis has two various shapes manifestations are acute and chronic necrosis of the renal papillae. Acute, manifested by pain in the form of colic, chills and blood in the urine. In a week, acute renal failure may develop and the outflow of urine may stop. Chronic, the presence of bloody inclusions in urine is diagnosed, the pain is not sharp, it is accompanied by diseases of the urinary system.

To treat this type of disease, first eliminate the cause of its appearance, for example, put a catheter on the ureter to remove the blockage. Then various drugs are used to relieve spasms, pain and maintain the patient's immunity.

With the ineffectiveness of conservative treatment, surgical intervention is used to remove the organ.

The disease is diagnosed by X-ray. Papillae may be present in the urine.

Acute tubular (tubular)

With tubular necrosis, the epithelium of the renal tubules suffers. Depending on the nature of occurrence, it happens:

1. Ischemic. It develops after stress, trauma, inflammation, shock. There is a squeezing of the vessels, as a result, the blood flow is disturbed.
2. Nephrotoxic. It develops after poisoning with toxic substances and drugs. Such a reaction can be caused by the poison of some snakes.

This type of disease destroys the renal tubules, which leads to a strong infectious and inflammatory process that penetrates all tissues of the organ and leads to acute renal failure.

Symptoms of the destruction of the renal tubules will be: a state of coma, edema, problems with urination (up to its complete absence), delirium, nausea.

Treatment for tubular necrosis is prescribed by removing the cause of the occurrence. Restore blood flow and filter the blood from harmful toxic impurities.

It is diagnosed with the help of complex studies: general and biochemical blood and urine tests, ultrasound, X-ray, CT and MRI.

Necrosis of the cortical substance of the kidneys (cortical)

Cortical necrosis is characterized by a pathological change in the tissue of the outer part of the organ. Symptoms are similar to acute renal failure. It is most often diagnosed in young children and pregnant women. The disease manifests itself after blockage of the arteries of the cortical layer, against the background of bacterial infections received. In the cortex, glomerular loops are affected.

The cause of cortical necrosis is an infectious process that occurs after an abortion in non-sterile conditions, with the development of a state of shock. Under such conditions, the blood begins to circulate only through the central arteries, while it does not enter the cortical layer of the kidneys.

The symptoms of such processes are quite diverse:

1. Isolation of blood inclusions along with urine.
2. Decreased or stopped urination.
3. Pain syndrome in the lower back, abdomen.
4. Symptoms of intoxication: vomiting, nausea, fever.

Most cases of cortical necrosis occur in pregnant women who have placental abruption, uterine bleeding, etc.

The diagnosis is confirmed by ultrasound.

Caseous and focal necrosis

Caseous necrosis (curdled) appears as a complication of tuberculosis, syphilis and leprosy. Received its place in the classification due to its curdled appearance. It is almost impossible to notice the disease in the initial stages, due to the asymptomatic course of the underlying diseases.

Focal necrosis is characterized by a point (local) lesion of the glomeruli of the kidney, while others function normally.

Treatment

Initially, in the treatment of kidney necrosis, they try to remove the root cause of the appearance of this process. In most cases, antibacterial therapy is carried out, antispasmodics and analgesics are prescribed.

Depending on the type of necrosis, the following activities are carried out:

1. With necrosis of the renal papillae, antispasmodics are the first to be prescribed. To unblock the ureter, a catheter is placed. Antibiotics, blood thinners and immunostimulants are used.
2. With cortical necrosis, blood flow in the brain tissue is restored. The patient is prescribed procedures on the "artificial kidney" apparatus. Antibiotic therapy is used to eliminate foci of infection.
3. With tubular necrosis, the drugs used are adjusted, antibacterial drugs are prescribed, procedures are carried out to cleanse the bloodstream and the body of toxins.

In severely neglected cases, when drug and physiotherapy do not help, they resort to surgical intervention. The kidney is removed entirely or only the area affected by necrosis is removed.

If a thrombus is found in the vessels of the kidney, removal does not occur, specialists use a special balloon to remove the blockage, and drug treatment continues.

Forecast

With early diagnosis of kidney necrosis, the prognosis is favorable. All dead areas and areas are removed, within a certain time they are scarred. The patient continues to live his usual life, with some adjustments.

With late detection, in the vast majority of cases, kidney transplantation is required. And in very advanced cases, there is a possibility of death. Therefore, it is so important to monitor your health, undergo dispensary control on time, and if you suspect the presence of any disease, contact your doctor.

HEMORRHAGIC CORTICAL RENAL NECROSIS(Greek, haimorrhagia bleeding; lat. corticalis cortical; necrosis; syn. symmetrical cortical necrosis of the kidneys) - a disease caused by spasm and thrombosis of the renal vessels, followed by necrosis of the glomeruli and tubules of the cortical layer of the kidneys and clinically manifested as acute renal failure.

G. k. n. n. was first described by the French. doctor E. Juhel-Renou in 1886. The largest number of patients with this pathology is presented in the work of Sheehan and Moore (H. L. Sheehan, H. C. Moore, 1953). In childhood, the disease occurs mainly in boys in the neonatal period and only in 10% of cases older than 2 years? W adult G. k. n. the item is more often observed in women aged 20-35 years.

Etiology and pathogenesis

One of the causes of cortical necrosis of the kidneys can be a hemolytic process (hemolytic disease of the newborn, hemolytic-uremic syndrome, etc.), intrauterine and postpartum hypoxia and fetal asphyxia.

In women, the development of the disease is associated with abundant meno- and metrorrhagia, as well as with pathology during pregnancy and childbirth (premature placental abruption, massive placental hemorrhages, placenta previa, eclampsia) and intensive treatment with vasoconstrictors (oxytocin, norepinephrine). A smaller role in G.'s etiology to. items play surgical interventions, burns, severe infections, disseminated neoplasms.

At the heart of G.'s pathogeny to. items lie violations of the renal circulation by the type of ischemia that occurs in various patol, conditions. With ischemia lasting up to 3 hours. predominantly tubules are affected, longer ischemia leads to necrosis of the cortex.

pathological anatomy

Macroscopically, the kidneys are enlarged, dark red or chocolate in color, edematous, flabby. The cortical substance is thinned. There are many areas of necrosis and hemorrhages on the surface of the kidneys and on the cut. Pyramids of the kidney and mucous membrane of the pelvis without changes. At gistol, a research find multiple thrombuses of interlobular arteries and bringing arterioles, in places of accumulation of lymphoid cells in interstitial fabric. In the future, mineralization (calcification) of necrobiotic areas is possible.

Clinical picture

Kidney damage in newborns and infants develops against the background of otitis, mastoiditis, meningitis, nasopharyngitis. The leading symptom of G. to. the item at newborns is anuria (see), to-ruyu it is difficult to diagnose owing to fiziol, oligurias (see) in the first days of life. The disease is accompanied by fever, vomiting, diarrhea, dehydration, erythrocytes, leukocytes, hyaline and granular casts are noted in the urine. There is moderate anemia, hyperleukocytosis, neutrophilia with a shift to the left, thrombocytopenia. Edema and arterial hypertension are usually absent. In nevrol, the status anxiety, spasms, and then drowsiness, a hypotonia prevail in the beginning, the coma develops with disturbance of breath and swallowing. In the terminal stage, hematemesis joins (see Hematemesis) and melena (see). In adults, in addition, severe back pain is noted. Changes from other bodies are connected with the disease preceding G. to. P.

G. k. n. the item can be complicated by progressive anemia, cerebral edema (see Edema and swelling of the brain), nephrotic syndrome (see).

Diagnosis

The diagnosis is made on the basis of clinical, laboratory and rentgenol. data. According to laboratory data, G. Ph.D. the item is identical to acute renal failure (oliguria, anuria, azotemia, hyperkalemia, metabolic acidosis). ECG shows signs of hyperkalemia. Radiologically, the kidneys are enlarged. Biopsy reveals necrosis of the cortical layer of the kidneys.

Differential Diagnosis carried out with anuria of various nature (malformations of the kidneys, glomerulonephritis, etc.).

Treatment

Treatment is aimed primarily at eliminating anuria and acute renal failure. The amount of fluid administered per day should correspond to the amount of urine excreted (for children of the first year of life - no more than 30 ml per 1 kg of body weight per day). The introduction of fluid is carried out under the control of water-salt balance and acid-base balance. To prevent protein catabolism, lipids and concentrated glucose are administered intravenously. Due to the presence of foci of infection, antibiotic therapy is carried out with non-toxic drugs (oxacillin, methicillin and other penicillin derivatives). In order to improve renal hemodynamics, heparin is indicated (100-120 units / kg intravenously). In the absence of the effect of symptomatic therapy, they resort to exchange blood transfusion (see), peritoneal dialysis (see), as well as hemodialysis (see).

Forecast

The prognosis is bad. Death usually occurs on the 10-15th day from the onset of the disease. Recovery is noted in some cases.

Bibliography: Diseases of the kidneys, ed. G. Mazhdrakova and N. Popova, trans. from Bulgarian, p. 533, Sofia, 1973, bibliogr.; Guide to clinical urology, ed. A. Ya. Pytelya, M., 1969; Bouissou H. e. a. La pesgoe corticale sym6trique des reins du nourrisson (fitude clinique, etiolo-gique et th6rapeutique), Ann. P6diat., t. 10, p. 2317, 1963; Juhel-RenoyE. De l'anurie precoce scarlatineuse, Arch. g£n. M6d., t. 17, p. 385, 1886; Sheehan H. L. a. Moore H. C. Renal cortical necrosis and the kidney of concealed accidental haemorrhage, Oxford, 1953.

V. P. Lebedev.

The site provides background information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

Children are cute creatures that quite often make us parents pretty worried. Moms and dads pay special attention to the general health of their beloved children. This is not surprising, since only a healthy baby can be truly happy. Unfortunately, things don't always turn out well. These or other ailments quite often burst into the life of a child, and quite suddenly. Those children who day after day adhere to all the rules of a healthy lifestyle are no exception. site) will talk about diseases such as papillary and cortical necrosis kidneys in children. After reading the information provided, you can find out everything you need about the causes of development, symptoms, diagnosis, as well as methods of treating these ailments.

What is papillary necrosis of the kidneys in children?

In fact given state in most cases, it is a consequence of such ailments as diabetes mellitus, pyelonephritis, nephrolithiasis, hypertension and some others. Very rarely, this ailment makes itself felt as a primary kidney disease. By this disease is meant a condition in which there is a clear circulatory disorder directly in the pyramids of the kidneys. Modern doctors and specialists distinguish two forms of this disease - these are unilateral and bilateral necrosis.

What is renal cortical necrosis?

This condition is characterized by damage to the interlobular arcuate arteries, which can cause the development of ischemic necrosis of the entire renal tissue. We draw your attention to the fact that this pathology is observed, as a rule, in infants only.

What are the causes of papillary and cortical necrosis?

As for the first condition, it occurs as a result of exposure to the body of the child Escherichia coli. Infection can occur both by contact and hematogenous route. If we talk about the reasons for the development of the second state, then in this case bacterial infections such as staphylococcus, meningococcal infection, streptococcus and some others are to blame.

What is the clinical manifestation of papillary necrosis of the kidneys?

The very first symptoms of this pathology are considered to be a significant deterioration in the general well-being of the child against the background of the main ailment. The baby has a fever, chills and oligoanuria. In addition, the face also has hematuria, leukocyturia and bacteriuria. In the urine of such children, you can see separate parts of the renal papillae. In the presence of this disease, the child is also disturbed by quite strong pain sensations, which can be observed both in the abdomen, and in the lower back, or in the region of the kidney itself. When passing urine tests, there is also a clear leukocytosis.

What are the symptoms of renal cortical necrosis in children?

The most common signs of this disease include: hyperazotemia, oligoanuria, electrolyte disorders, as well as some other symptoms that are observed in renal failure. Note that the strength of the manifestation of all these signs directly depends on the degree of the necrotic process.

How are these conditions diagnosed?

To identify these pathologies, such a diagnostic method as excretory urography is used. Excretory urography is an X-ray method for examining the urinary tract, which is based on the ability of the kidney to excrete certain radiopaque substances.

What are the treatments for these ailments?

As for the therapy of papillary necrosis, it involves the treatment of an existing bacterial infection. In this case, the sick child is prescribed drugs with a wide antimicrobial spectrum of action. But in the case of cortical necrosis, in the very first place, all efforts are directed to the elimination of signs of acute renal failure. In this case, antibacterial and symptomatic therapy comes to the rescue, based on the use of antihypertensive, as well as diuretic drugs.

Thanks to the global connections that intertwine the entire planet modern world like it got smaller. Under these conditions, the role of education has increased significantly - the prosperity of the state cannot take place without effective work education system, as well as other factors of socio-economic development. In order to somehow compare the quality of the education system, experts came up with a number of metrics (PIRLS, PISA, TIMSS). Based on these metrics and other parameters (number of graduates in the country, literacy rate), since 2012, the Pearson group has been publishing its own index for various countries. In addition to the index, learning progress and thinking skills are taken into account. This year the list of countries with the best education is as follows:

For modern man even now, the ability to read remains the most important basic skill, despite the dominance of colored buttons, pictures and pictograms. N...

1. Japan

This country is the most advanced in the level of many technologies, and the reform of the educational system put it in the first place in this ranking. The Japanese were able to radically change the model of education, create an effective control system in it. When the country's economy suffered a complete collapse, education was seen as the only source of its development. Japanese education has long history, and now it keeps its traditions. His system is based on high technology, which allows the Japanese to lead the way in understanding problems and the level of knowledge. The literacy rate of the population here is almost 100%, but only elementary education is required here. For many years, the Japanese education system has been aimed at preparing schoolchildren for employment and fruitful participation in public life. Here, children are required to produce results that correspond to their abilities. Academic plan in Japan is strict and dense, and schoolchildren learn a lot about the cultures of the world. Particular emphasis is placed on practical exercises.

2. South Korea

About 10 years ago, there was nothing special to say about the Korean education system. But the rapid development of the South Korean economy has dramatically pushed it into the list of the world's leading ones. There is a large percentage of people here higher education and not because learning has become fashionable, just learning has become a principle of Korean life. Modern South Korea leading in terms of technological development, and this could only be achieved by government reforms in the field of education. It allocates $11.3 billion annually for education. The country is 99.9% literate.

3. Singapore

The population of Singapore has a high IQ. Particular attention is paid here to the quality and volume of knowledge, but also to the students themselves. At the moment, Singapore is one of the richest countries and at the same time, one of the most educated. For the success of the country, education plays a crucial role, so people here are spending on it without stint - annually investing 12.1 billion dollars. The literacy rate in the country is above 96%.

4. Hong Kong

This piece of mainland China is notable for the fact that researchers have determined that its population has the highest IQ. The literacy of the population and the education system here are at a very high level. Thanks to a well-thought-out education system, success in development here has also become possible. high technology. Hong Kong is one of the "business centers" of the world, it is well suited for quality higher education. And high level here they have different levels of education: not only higher, but also primary and secondary. Teaching is conducted in the local dialect of Chinese and English language. Schooling, lasting 9 years, is compulsory for all in Hong Kong.

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5. Finland

The educational system in Finland gives students and schoolchildren maximum freedom. Education is completely free in the country, and the school administration even pays for meals if the student spends a full day in the school. Here they are actively engaged in attracting applicants to the country's universities. Finland leads in such an aspect as the number of people who consistently complete any form of education. The country allocates significant resources for education - 11.1 billion euros. Thanks to this, it was possible to build a solid educational system here from the initial level to the higher one. Finnish schools are free to choose educational materials and teachers here must have a master's degree. They are given wide freedom in terms of organizing classes in their classes.

6. UK

This country has long formed the best in the world education system. The UK is traditionally known for its excellent education, especially at the university level. The University of Oxford is considered to be a reference university in the world. In the field of education, Great Britain is a pioneer, for many centuries it was here that the education system was formed within the walls of ancient English universities. But as regards the primary and secondary levels of education, much less attention is paid to them here, and only higher education is considered impeccable. This does not allow the UK to lead this ranking, and even in Europe it ended up in second place.

7. Canada

The level of higher education in Canada has reached such a high level that in order to receive it in this country in last years more and more foreign youth began to aspire. At the same time, the rules for obtaining education may differ in different Canadian provinces, but the common thing for the whole country is that the Government of Canada pays a lot of attention to the issues of standards and quality of education everywhere. share school education in the country is especially high, but fewer young people strive to continue to receive it in universities than in the countries already mentioned. Funding for education is mainly handled by the government of a particular province, that is, the Canadian education system shows a clear decentralized nature. Therefore, each province controls its own curriculum. Teaching practices and teaching staff here are subject to strict selection. The introduction of technology and constructive interaction with the families of students make education more advanced. Education in Canada is conducted in English and French.

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8. Netherlands

The quality of Dutch education is evidenced by the fact that the population of this country is recognized as the most well-read in the world. Here, all levels of education are free, although there are paid private schools in the Netherlands. The peculiarity of the local education system is that students under the age of 16 must devote their whole day to learning. Adolescents can now further choose whether to continue studying all day or reduce the time of study, which determines whether they will pursue higher education or settle for elementary education. In the Netherlands, in addition to secular educational institutions, there are also religious ones.

9. Ireland

The Irish education system is also considered one of the best in the world, if only because of its absolute freeness, including in colleges and universities. Such successes in the field of education did not go unnoticed in the world, so this modest island also got such an honorable rating. Currently, Icelandic education has a clear bias towards learning and teaching Irish. Primary education is compulsory for all Irish children and all educational establishments, including private ones, financed by the government of the country. Its goal is to provide quality and free education to all inhabitants of the island and at all levels. Therefore, 89% of the Irish population has completed compulsory secondary education. But free education does not apply to foreign students - even young people who come from the European Union have to pay tuition here, and if they work here at the same time, they pay taxes.

10. Poland

As early as the 12th century, an education system began to take shape in Poland. Interestingly, it was here that the first Ministry of Education appeared, which to this day does an excellent job with its tasks. The success of Polish education has a variety of confirmations, for example, Polish students have repeatedly become winners of various international competitions in mathematics and fundamental sciences. The country has a very high literacy rate. Due to the consistently high quality of education, Polish universities are listed in many countries. Students from abroad also tend to come here.

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Literacy is a key skill and a key measure of population education. In 1820, only 12% of the world's people could read and write. Today, only 17% of the world's population remains illiterate. The literacy rate in the world is on the rise.

Despite significant expansion and constant contraction, humanity has serious tasks ahead. AT poorest countries world, access to basic education is such that large segments of the population remain illiterate. This limits the development of the whole society. For example, in Niger, the youth literacy rate (15-24 years old) is 36.5%.

In the Western Equator Province of South Sudan, a national "back to learning" campaign was launched targeting 400,000 children. 2015, Yambio, South Sudan. Photo: UN/JC McIlwaine

The global literacy rate is on the rise

The earliest forms of writing arose five to five and a half thousand years ago, but literacy for centuries remained the lot of the elite - the technology of exercising power. Only in the Middle Ages, along with the development of printing, the level of literacy of the people of the Western world began to change. In fact, the ambitions of universal literacy of the Enlightenment were able to approach reality in the 19th and 20th centuries in early industrial countries, notes OurWorldInData.

: By 2030, ensure that all young people and a significant proportion of the adult population, both men and women, can read, write and count.

World Literacy Assessment 1800–2014

(percentage of literate and illiterate people in the world)

Literacy rates steadily increased until the early twentieth century. It was not until the mid-20th century, when the expansion of basic education became a worldwide priority, that the rate of growth in literacy rates picked up.

Literacy rate of young people and older people

To assess progress in the future, it is convenient to distribute literacy scores by age group. The following map, using UNESCO data, shows such estimates for most countries in the world. They show a big difference in literacy levels of different generations (you can see the literacy rate for different age groups by clicking on the corresponding button above). The large difference in the literacy levels of individual generations indicates a global trend in the growth of literacy of the entire population.

What is called literacy?

According to a 1958 UNESCO resolution, illiterates are people who cannot read and write a short, simple statement about their daily lives ( for achievements in the field of education of individual countries, see, 2016, pp. 230-233).