Renal trauma

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Background

  • Approximately 10% of blunt injuries include renal trauma
  • Blunt mechanism 9x more common than penetrating[1]

Clinical Features

  • Flank pain
  • Hematuria (gross or microscopic)
  • Page kidney (late finding) - hypertension resulting from long-standing compression of from renal parenchyma by subcapsular hematoma

Differential Diagnosis

Abdominal Trauma

Evaluation

AAST Grading System for renal injuries

  • Non-operative management[2]
    • Grade I: Cortex contusion
    • Grade II: Cortex laceration
  • Possible operative management
    • Grade III: Corticomedullary junction laceration
    • Grade IV: Collecting system laceration
  • Operative management
    • Grade V: Shattered kidney, thrombosis of renal artery, avulsion of hilum

Management

  • Based on grade of injury (above)
  • Absolute indications for operative renal exploration and intervention:
    • Life-threatening hemorrhage
    • Expanding, pulsatile, or non-contained retroperitoneal hematoma
    • Renal avulsion injury
  • Page kidney treatment involves ACE inhibitor and possible drainage of hematoma

Disposition

Admit

  • Penetrating renal injuries
  • Gross hematuria
  • Grade II or higher injury

Discharge

  • Microscopic hematuria and no indication for imaging
  • Isolated renal trauma with Grade I injury
    • Ensure close followup and instruct no heavy lifting

See Also

GU Trauma

References

  1. Miller, K. S. and McAninch, J. W. (1995) ‘Radiographic Assessment of Renal Trauma’, The Journal of Urology, pp. 352–355.
  2. Shariat, S. F., Roehrborn, C. G., Karakiewicz, P. I., Dhami, G. and Stage, K. H. (2007) ‘Evidence-Based Validation of the Predictive Value of the American Association for the Surgery of Trauma Kidney Injury Scale’, The Journal of Trauma: Injury, Infection, and Critical Care, 62(4), pp. 933–939.