Renal trauma: Difference between revisions

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**Expanding, pulsatile, or non-contained retroperitoneal hematoma
**Expanding, pulsatile, or non-contained retroperitoneal hematoma
**Renal avulsion injury
**Renal avulsion injury
*ACE inhibitor therapy and possible drainage of hematoma for Page syndrome


==Disposition==
==Disposition==

Revision as of 23:57, 29 August 2016

Background

  • Blunt mechanism 9x more common than penetrating[1]
    • However GSW associated with higher AAST grade
  • Approximately 10% blunt injuries include renal trauma

Clinical Features

  • Flank pain
  • Gross hematuria
  • Microscopic hematuria
  • Page kidney - hypertension from renal parenchyma compression 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

  • Absolute indications for renal exploration and intervention:
    • Life-threatening hemorrhage
    • Expanding, pulsatile, or non-contained retroperitoneal hematoma
    • Renal avulsion injury
  • ACE inhibitor therapy and possible drainage of hematoma for Page syndrome

Disposition

Admit

  • All penetrating renal injuries
  • All gross hematuria
  • All grade II and higher injuries

Discharge

  • Microscopic hematuria and no indication for imaging
  • Isolated renal trauma and contusion-type grade I injury
    • Instruct no heavy lifting; follow up in 1-2wk to document resolution of the hematuria
  • Grade I subcapsular hematoma can discharge'd with 24hr follow up

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.