Renal trauma: Difference between revisions
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==Background== | ==Background== | ||
[[File:Blausen 0592 KidneyAnatomy 01.png|thumb|Renal anatomy.]] | |||
[[File:PMC5265200 13244 2016 536 Fig1 HTML.png|thumb|Perinephric space with exaggerated pararenal space to show retroperitoneal structures. Perinephric bridging septa are seen between the left kidney and the adjacent renal fascia.]] | |||
*Approximately 10% of blunt injuries include renal trauma | *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> | ||
Revision as of 11:23, 2 May 2020
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
Workup
- CT with contrast
Diagnosis
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)
- Prophylactic IV antibiotics for grade IV, V injuries (first generation cephalosporin, ciprofloxacin, or ampicillin and gentamicin)
- 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.