Kidney and Urologic DiseasesVerified data

Renal Hypoperfusion - Causes, Diagnosis, and Treatment

Creator: Dr. Shaikh Adibanaz Jamil Ahemad
Published: 2023-04-03T17:49:07

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Renal hypoperfusion is a sudden decrease in the supply of blood to the kidney. Read the article to know more about it.

Written by

Dr. Shaikh Adibanaz Jamil Ahemad

Medically reviewed by

Dr. Yash Kathuria

April 3, 2023

January 22, 2024

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Contents

What Could Be Causing This Rare Disease?
How Can This Disease Be Identified?
How Can This Disease Be Diagnosed?
How Can This Disease Be Treated?
What Are Various Surgical Interventions?
What Could Be the Possible Postoperative Complications?
What Are Some Complications After Getting This Disease?
When to See the Doctor?

Introduction:

The gastroduodenal disease comes under the inflammatory bowel disease (IBD) category, which has only two subtypes. One is this disease, and the other one is ulcerative colitis. It is a type of disease that can be present lifelong. Gastroduodenal Crohn's disease is a rare condition that accounts for only four percent of all Crohn's disease cases. It has no cure as of now but treating the symptoms will reduce the severity. The duodenum is the first part of the intestine, which is present immediately after the stomach. The jejunum is the second part of the intestine.

What Could Be Causing This Rare Disease?

The exact cause remains a mystery, but scientists are stating that genetics could be a factor since 200 variants have been identified as possible outcomes for developing this disease. Nonsteroidal anti-inflammatory drugs or oral contraceptives could also play a vital role in its etiology, but this is not yet confirmed. The other factors that could be playing a role in causing this are as follows.

Sedentary lifestyle.
Diet.
Smoking.
Improper hygiene practices.

How Can This Disease Be Identified?

The most common symptom is upper abdominal pain, which does not radiate to other parts of the body, often presents itself after eating, and can usually be relieved by antacids.
Nausea and vomiting, along with constant pain in the abdomen, cause gastric outlet obstruction due to the formation of strictures, which is an abnormal narrowing of a passage in the gastroduodenal region.
Loss of blood can appear in the form of chronic anemia.
Anorexia (fear of gaining weight).
Weight loss.
Loss of appetite.
Pain in the upper abdomen.
Upper gastrointestinal abnormalities.

How Can This Disease Be Diagnosed?

The diagnosis of this disease needs more attention since it can easily be confused with lower gastrointestinal tract disease. Hence, good imaging and endoscopic techniques should be used to diagnose properly. With the help of biopsy, endoscopy is most widely used in diagnosing this disease.

Endoscopic Findings:

Accumulated blood in the dilating blood vessels leads to an abnormal redness of the skin or mucous membrane, which is otherwise called erythematous patches.
The mucosa (the inner lining of an organ like the stomach) becomes weak and bleeds easily, leading to mucosal friability.
The nodular appearance of the mucosa in the gastroduodenal region.
The earliest sign of Crohn's disease is an aphthous ulcer, a small sore occurring in the mouth or base of the gums.

Radiographic Findings:

Mucosal nodules (a lump or growth that can be cancerous).
Cobblestone thickened folds.
Ulcerations.
Diffused inflammation.
An end-to-end anastomosis pattern can be noticed between the antrum and proximal duodenum in radiographs.
Deformity of diseased antrum can show a funnel-shaped appearance in radiographs called Ram's horn sign, as the stomach resembles the horn of a ram (male sheep).
Advanced stages of the disease can be evaluated by using radiographs.
Non-caseating granulomatous inflammation of the stomach or the duodenum.
Contagious gastroduodenal involvement is the most common, with patients having diseased antrum, pylorus, and proximal duodenum.

Pathological Features:

Swelling is due to excess fluid in the mucosal region, called mucosal edema.
Acute or chronic inflammation.
Inflammatory cells accumulate in the crypts of the gastrointestinal tract, which is called crypt abscess.
Connective tissue thickening, which is termed fibrosis, extends into the muscularis mucosa.
Helicobacter pylori is the most common type of microorganism found in the disease.

How Can This Disease Be Treated?

Acid suppression should be the primary goal since it tends to cause inflammation.
Proton pump inhibitors can be a good option.
Corticosteroids like six Mercaptopurine and Azathioprine can be combined early in the disease with proton pump inhibitors to maintain corticosteroid-induced remission.
Narrowing a passage in the gastrointestinal region called strictures can sometimes become complicated.
If the duodenal strictures are short, endoscopic balloon dilation with a rigid-flex balloon (8 mm) or microwave balloon (10 mm) can be used with a perforation risk of 1 to 2 mm.
Some patients may require surgery, especially when they have a duodenal obstruction or refractory ulcer-type abdominal pain.
To analyze the extent of the spread of the disease and what mode of treatment shall be given.
Upper gastrointestinal tract endoscopy.
Small bowel radiotherapy.
Colonoscopy.

What Are Various Surgical Interventions?

Bypass surgery by creating a connection between the stomach and the jejunum, called gastrojejunostomy, is performed to bypass the duodenal stricture.
Gastroduodenostomy (connecting the stomach and the duodenum by surgery).
Duodenojejunostomy (surgically connecting duodenum and jejunum).
Stricturoplasty (a surgical procedure to correct the narrowing of the bowel).

What Could Be the Possible Postoperative Complications?

The complications include:

Collection of gasses inside the abdomen.
An anastomotic leak occurs when the connection that was made surgically fails to connect or heal properly.
The enterocutaneous fistula is a connection between the stomach or intestinal tract and the skin.
Stomal ulcerations are the development of ulcers in the gastrointestinal region after surgery.
There might be diarrhea and ulcers after bypass surgery. Thus, performing gastrojejunostomy with highly selective vagotomy would preserve the autonomic innervation to the small bowel.
Emptying of gasses may be delayed postoperatively after bypass surgery and even after a stricturoplasty.
Patients undergoing stricturoplasty had higher rates of repeated surgery.

What Are Some Complications After Getting This Disease?

Narrowing the stomach and the duodenum due to strictures can obstruct the gastric outlet, the most common complication of gastroduodenal Crohn's disease.
Fistulas are abnormal connections between two body parts, like an organ, blood vessel, and another structure.
Gastrocolic fistula, formed between the distal transverse colon and stomach, is the most common fistula encountered, which causes diarrhea, feculent vomiting, and weight loss.
Pancreatitis can occur due to the reflux of contents from the duodenum into the pancreatic duct. This is a rare complication.

When to See the Doctor?

The person should see the doctor if they experience signs and symptoms of this condition such as

Bloody stools.
Diarrhea which persists for a week.
Continuous stomach pain.
Sudden weight loss.
Slow growth in children.

Can Gastroduodenal Crogn’s Condition Be Prevented?

There are no ways to prevent this condition. However, the symptoms can be managed by following a proper Crohn’s diet, reducing stress, and avoiding smoking.

Conclusion:

Gastroduodenal involvement in Crohn's disease is a rare condition that is characterized by inflammation of the duodenum, but the symptoms can be treated with the right diagnosis. Though many other diagnostic methods have come, endoscopy remains the gold standard for diagnosing this rare disease. This condition is usually treated with the help of medications and surgery.

Frequently Asked Questions

1. What Does the Term “Prerenal Kidney” Mean?

A prerenal kidney refers to a condition in which reduced blood flow to the kidneys impairs their function. It is caused by factors that affect blood circulation before reaching the kidneys, such as dehydration, blood loss, reduced cardiac output, blood vessel abnormalities, or certain medications. Insufficient blood flow to the kidneys can lead to decreased urine production, electrolyte imbalances, and impaired kidney function.

2. How Do Prerenal and Intrarenal Kidney Conditions Differ From Each Other?

The main difference between prerenal and intrarenal conditions is their location and underlying causes. Prerenal conditions are caused by factors external to the kidneys, such as reduced blood flow due to dehydration or blood loss, leading to impaired kidney function. Intrarenal conditions, on the other hand, occur within the kidney tissue itself and are often the result of diseases or disorders that directly affect the kidneys, such as inflammation or damage to the filtering units or tubules.

3. How Renal Blood Flow and Blood Pressure Are Associated?

- Renin-Angiotensin-Aldosterone System (RAAS): Decreased renal blood flow stimulates the release of renin, which initiates the production of angiotensin II. Angiotensin II constricts blood vessels, increases peripheral resistance, and raises blood pressure.
- Sodium and Water Retention: In response to reduced renal blood flow, the kidneys release aldosterone, which promotes sodium and water reabsorption. This leads to increased blood volume, which contributes to elevated blood pressure.
- Vasopressin (Antidiuretic Hormone, ADH) Release: Decreased renal blood flow triggers the release of vasopressin, which promotes water reabsorption in the kidneys, conserving water and contributing to blood volume expansion and increased blood pressure.
- Sympathetic Nervous System Activation: Reduced renal blood flow activates the sympathetic nervous system, causing the release of norepinephrine. Norepinephrine causes vasoconstriction, increasing peripheral resistance and raising blood pressure.
- Regulation of Fluid and Electrolyte Balance: The kidneys play a crucial role in maintaining fluid and electrolyte balance. Disruptions in renal blood flow can lead to imbalances, such as decreased sodium excretion, which can contribute to increased blood pressure.

4. What Is the Association Between Blood Pressure and Urine Output?

The relationship between blood pressure and urine output is that the kidneys regulate blood pressure by adjusting urine output. When blood pressure is high, the kidneys increase urine output to eliminate excess fluid and reduce blood volume, thus lowering blood pressure. However, when blood pressure is low, the kidneys reduce urine output to conserve fluid and maintain blood volume, which helps increase blood pressure. By controlling the excretion of water and sodium in the urine, the kidneys play a crucial role in maintaining fluid balance and influencing blood pressure levels in the body.

5. How Does Renal Failure Cause Hypernatremia and Hyponatremia?

Renal failure can lead to hypernatremia and hyponatremia, depending on the underlying factors and mechanisms involved.
- Hypernatremia (high sodium levels) in renal failure can occur due to impaired kidney function, which impairs the excretion of sodium, leading to its accumulation in the body. This can be exacerbated by fluid imbalances or reduced water intake.
- Hyponatremia (low sodium levels) in renal failure can occur due to the inability of the kidneys to regulate water balance effectively. The kidneys may fail to excrete excess water, resulting in dilutional hyponatremia.

6. What Is the Role of Sodium in Renal Failure?

In renal failure, the kidneys are unable to function properly, leading to disturbances in sodium balance. The specific effect on sodium levels depends on the type and stage of renal failure. Here's a general overview of what happens to sodium in renal failure:
- Hypernatremia: In some cases of renal failure, particularly in advanced stages or when there are fluid imbalances, hypernatremia (high sodium levels) can occur. The impaired kidney function leads to a reduced ability to excrete sodium, resulting in its accumulation in the body.
- Hyponatremia: Hyponatremia (low sodium levels) can also be seen in renal failure. It often occurs due to the kidney's inability to properly regulate water balance. The kidneys may fail to excrete excess water, leading to dilutional hyponatremia.

7. Is Hyponatremia Seen in Chronic Kidney Disease?

Hyponatremia (low sodium levels) can occur in chronic kidney disease (CKD), particularly in advanced stages or in the presence of other factors. The prevalence of hyponatremia in CKD varies, but it is relatively common, especially in more severe cases. Multiple factors contribute to hyponatremia in CKD, including impaired water excretion, fluid overload, medications, and comorbidities. Hyponatremia in CKD can have various implications on health and may require management, such as fluid restriction, diuretic therapy adjustment, or addressing the underlying cause. Regular monitoring of sodium levels and appropriate management are important aspects of CKD care.

8. Where Does Absorption Take Place in the Kidneys?

Reabsorption takes place primarily in the renal tubules of the kidneys. This includes the proximal convoluted tubule, loop of Henle, distal convoluted tubule, and collecting ducts.
- The proximal convoluted tubule is responsible for the reabsorption of water, glucose, amino acids, and ions.
- The loop of Henle is involved in the reabsorption of water and regulation of concentration gradients.
- The distal convoluted tubule and collecting ducts further fine-tune reabsorption based on hormonal signals, such as aldosterone and antidiuretic hormone.
- Overall, reabsorption is an essential process that ensures the retention of vital substances and the maintenance of fluid and electrolyte balance in the body.

9. Is Electrolyte Imbalance Common With Renal Failure?

Electrolyte imbalances are common in renal failure, and several specific imbalances can occur. The most common electrolyte imbalances seen in renal failure include:
- Hyperkalemia: Increase the levels of potassium in the blood due to impaired kidney function and reduced ability to excrete potassium. Hyperkalemia can have serious cardiac implications.
- Hyponatremia: Low sodium levels in the blood. Hyponatremia can occur in renal failure due to the kidneys' impaired ability to properly regulate water balance.
- Metabolic Acidosis: Reduced ability of the kidneys to excrete acid or reabsorb bicarbonate can lead to an accumulation of acid in the blood, resulting in metabolic acidosis.
- Hyperphosphatemia and Hypocalcemia: Decreased kidney function can lead to an increase in phosphorus levels and a decrease in calcium levels in the blood. This can disrupt the balance between these two electrolytes and contribute to complications such as bone mineral abnormalities.

10. Why Is Electrolyte Level High in Kidney Failure?

Electrolytes can be high in kidney failure due to the kidneys' impaired ability to regulate and excrete them. In kidney failure, the filtration and reabsorption processes are compromised. This can lead to an accumulation of electrolytes in the bloodstream, such as potassium, phosphate, and sodium. Additionally, kidney failure can disrupt the body's acid-base balance, contributing to electrolyte imbalances. Certain medications and dietary intake can also impact electrolyte levels. Elevated electrolyte levels in kidney failure can have serious health consequences and require careful management, including dietary modifications, medication adjustments, and monitoring of electrolyte levels to prevent complications and maintain optimal health.

Sources

Dr. Yash Kathuria

Family Physician

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