Renal trauma
Background
- Blunt mechanism 9x more common than penetrating[1]
- Approximately 10% blunt injuries include renal trauma
Clinical Features
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
Diagnosis
AAST Grading System for renal injuries
- Non-operative management
- 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
Treatment
- Absolute indications for renal exploration and intervention:
- Life-threatening hemorrhage
- Expanding, pulsatile, or non-contained retroperitoneal hematoma
- Renal avulsion injury
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; f/u in 1-2wk to document resolution of the hematuria
- Grade I subcapsular hematoma can d/c'd w/ 24hr f/u
See Also
References
- ↑ Miller, K. S. and McAninch, J. W. (1995) ‘Radiographic Assessment of Renal Trauma’, The Journal of Urology, pp. 352–355.