RENAL TRAUMA

R.A.S HEMAT, MB;BCh, FRCSI, DUL.

Injuries from traffic or sport accidents, especially in the age groups between 15 and 35 years, are still considered as a major cause of death and disablement.

Penetrating trauma from stab or gunshot wounds accounts for 20-30% of all renal injuries. The final decision on whether to image a paediatric patient with a potential blunt renal injury must always be made based on history, physical findings and clinical status. Initial surgical intervention may only be necessary in those with associated intra-abdominal injuries or haemodynamic instability. Pathological fracture of the kidney shares some of the characteristics of pathological fracture of the bone. Trauma may be trivial or the extent of the haemorrhage may exceed that suspected based on the degree of injury. Hydronephrotic kidneys and large renal cysts can rupture with minimum trauma.

There are 24 classification of renal trauma with different criteria. There is a combination with the injury location in 87.5% of cases. A classification of renal trauma should consider its pathogenetic, morphological and prognostic factors independently of each other.

Sonography does not provide any information of renal function. It is suitable as an orientative screening method and for complementary follow-up. Radiologic diagnostic procedures competing among each other in their diagnostic yield and relevance. . The retroperitoneum in the region of the kidneys is divided into 5 compartments. The perinephric haematoma may also be caused by adrenal haemorrhage and hilar vessel laceration. Traumatic urinary obstruction caused by a blood clot in the collecting system may also result in hyperenhancement of the kidney.
The incidence of serious renal injury in patients with microscopic haematuria and no shock as well as without major associated injury is 0.05%.

Major lacerations, can be treated safely with a conservative approach, but repair would provide lower incidence of late complications such as nephrectomy. Vascular injuries involve serious haemorrhage and is life threatening requiring aggressive resuscitation. Assessment of the patient's fear and anxiety is essential if the patient is conscious during evaluation of the injury.

Principles of renal repair:
1- Total renal exposure.
2- Excessive bleeding require renal vessels clamping.
3- The renal pelvis, vessels, parenchyma and ureter must be carefully inspected.
4- In gunshot, debridment of the bullet pathway should be extensive.
5- Cooling using ice slush should be used if the ischaemia time due to vessels clamping is going to exceed 60 minutes.

The anatomic relations may be distorted by a large retroperitoneal haematoma, which requires careful inspection of the landmarks. Anteroperitoneal approach, an incision is made over the aorta just above and medial to the inferior mesenteric artery. Approximately 30% of one kidney will provide sufficient function to avoid dialysis.
Page kidney typically presents in healthy young man after blunt trauma to the flank or abdomen, although cases have been noted after medical or surgical interventions.
Patients who present with new-onset hypertension and hypokalemia with a history of trauma or coexisting vasculitis, the presence of Page kidney should be considered..etc.

Find more in Urotext, E. Book simplifying Urology.

Dr. R.A.S HEMAT declares no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, stock holdings, gifts, or honoraria.