AKI

Acute Kidney Injury

Acute Kidney Injury

Introduction

The necrotizing vasculitis consist of polyarteritis nodosa (PAN) macroscopic classical disease or Kussmaul and Maier, microscopic polyangiitis, Wegener's syndrome, or allergic granulomatous angiitis of Churg- Strauss syndrome. The case of hypersensitivity vasculitis called systemic lupus erythematosus, rheumatoid purpura, essential mixed cryoglobulinemia of endocarditis and Osler, which are predominant glomerular damage are not considered here. This vasculitis occurs rather between 50 and 70 but can occur at any age. They are more common in Caucasians and males. The annual incidence is estimated at one to two cases per 100 000 population in Europe and North America (Tabloski, 2010, pp. 211).

Stages of Kidney Injury

The renal lesions of necrotizing vasculitis are characteristic. In the macroscopic PAN, there is a breach of interlobular arteries and glomerular arterioles with an inflammatory infiltrate intraparietal and perivascular mononuclear cells made and granulocytes (Ronco et al, 2007, pp. 101). Crucially, there is necrosis of the vascular wall, with destruction of the elastic blade cuts seen after Weigert staining. The lesions are irregular, segmental and of different ages on a single cut. They evolve to fibrosis with wall thickening and reduction of the vascular lumen. Downstream arterial and arteriolar lesions, the glomeruli were ischemic, retracted into the chamber urinary glomerulus (Stein & Wild, 2002, pp. 245).

Examination by immunofluorescence not found deposits of immunoglobulin or complement, but shows the presence of fibrin in the lesions of necrosis. PAN in certain macroscopic and especially microscopic polyangiitis, the lesions are on the glomerular capillary and combine partial glomerular foci of necrosis with complete loss of glomerular basement membrane on liver staining and extracapillary cell proliferation, consisting of glomerular epithelial cells but also monocytes / macrophages, T lymphocytes and fibroblasts. Périglomérulaire an influx of inflammatory cells can be observed, as well as breaks in Bowman's capsule (Phillips, 1987, pp. 156).

No Endocapillary Proliferation

The severity of renal disease can be estimated by the percentage of glomeruli affected and the degree of extension extracapillary crescent. By immunofluorescence, the glomerular necrotizing is characterized by the absence of significant deposits of immunoglobulins and complement in the glomeruli. Fibrin deposits are visible in the glomerular necrosis and extracapillary proliferation. Very similar lesions can be observed in Wegener's syndrome, which differs, however, by the formation of noncaseating epithelioid granulomas. These are very characteristic granulomas when found in the interstitium of the kidney. Their interpretation is more difficult when they are located near or around an injured glomerulus because périglomérulaire the influx of inflammatory cells is also common in the NAP. The degree of glomerular sclerosis will determine the prognosis; the cell is growing in more favorable prognosis than fibrocellulaires or fibrous crescents (Moore, 2009, pp. 511).

Causes of Kidney Injury

The IRA of the macroscopic PAN usually occurs in the context of noise significantly affects the general condition with weight loss , inflammation, multiple extrarenal signs such as necrotic purpura, subcutaneous nouures, sensorimotor polyneuropathy asymmetric or not, and arthralgia arthritis. High blood pressure (hypertension) is associated with severe renal impairment, often greater than or equal to 180/120 ...