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
- 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
- Grade III: Corticomedullary junction 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
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.