Renal trauma: Difference between revisions
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==Background== | ==Background== | ||
*Approximately 10% of blunt injuries include renal trauma | |||
*Blunt mechanism 9x more common than penetrating<ref>Miller, K. S. and McAninch, J. W. (1995) ‘Radiographic Assessment of Renal Trauma’, The Journal of Urology, pp. 352–355. </ref> | *Blunt mechanism 9x more common than penetrating<ref>Miller, K. S. and McAninch, J. W. (1995) ‘Radiographic Assessment of Renal Trauma’, The Journal of Urology, pp. 352–355. </ref> | ||
==Clinical Features== | ==Clinical Features== | ||
*Flank pain | *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== | ==Differential Diagnosis== | ||
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===AAST Grading System for renal injuries=== | ===AAST Grading System for renal injuries=== | ||
*Non-operative management<ref>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.</ref> | *Non-operative management<ref>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.</ref> | ||
**Grade I: Cortex contusion | **'''Grade I:''' Cortex contusion | ||
**Grade II: Cortex laceration | **'''Grade II:''' Cortex laceration | ||
*Possible operative management | *Possible operative management | ||
**Grade III: Corticomedullary junction laceration | **'''Grade III:''' Corticomedullary junction laceration | ||
** | **'''Grade IV:''' Collecting system laceration | ||
*Operative management | *Operative management | ||
**Grade V: Shattered kidney, thrombosis of renal artery, avulsion of hilum | **'''Grade V:''' Shattered kidney, thrombosis of renal artery, avulsion of hilum | ||
==Management== | ==Management== | ||
*Absolute indications for renal exploration and intervention: | *Based on grade of injury (above) | ||
*Absolute indications for operative renal exploration and intervention: | |||
**Life-threatening hemorrhage | **Life-threatening hemorrhage | ||
**Expanding, pulsatile, or non-contained retroperitoneal hematoma | **Expanding, pulsatile, or non-contained retroperitoneal hematoma | ||
**Renal avulsion injury | **Renal avulsion injury | ||
*ACE inhibitor | *Page kidney treatment involves ACE inhibitor and possible drainage of hematoma | ||
==Disposition== | ==Disposition== | ||
===Admit=== | ===Admit=== | ||
* | *Penetrating renal injuries | ||
* | *Gross hematuria | ||
* | *Grade II or higher injury | ||
===Discharge=== | ===Discharge=== | ||
*Microscopic hematuria and no indication for imaging | *Microscopic hematuria and no indication for imaging | ||
*Isolated renal trauma | *Isolated renal trauma with Grade I injury | ||
** | **Ensure close followup and instruct no heavy lifting | ||
==See Also== | ==See Also== | ||
| Line 48: | Line 46: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Trauma]] | [[Category:Trauma]] | ||
[[Category:Renal]] | [[Category:Renal]] | ||
Revision as of 02:49, 2 September 2016
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
- Abdominal compartment syndrome
- Diaphragmatic trauma
- Duodenal hematoma
- Genitourinary trauma
- Liver trauma
- Pelvic fractures
- Retroperitoneal hemorrhage
- Renal trauma
- Splenic trauma
- Trauma in pregnancy
- Ureter 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
References
- ↑ Miller, K. S. and McAninch, J. W. (1995) ‘Radiographic Assessment of Renal Trauma’, The Journal of Urology, pp. 352–355.
- ↑ 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.