Kidney Trauma/Renal Failure
Animated Medical Illustration of the Human Kidney
Information About Renal Failure and Kidney Trauma
Most renal trauma occurs as the result of blunt trauma, and can be divided into vascular injuries, contusions, or lacerations.
Specifically, the major causes of renal injuries include the following types of trauma:
- Blunt (e.g. car accidents, recreational motor vehicle accidents, bicycle accidents, sports accidents, falls, pedestrian struck)
- Penetrating (e.g. gunshot wounds)
- Iatrogenic (e.g. renal biopsy)
- Other, such as a renal transplant rejection
Symptoms, Diagnosis, and Treatment
Those suffering from renal injuries typically complain of abdominal or flank pain. It is critical that medical professionals undertake a urinalysis and, based on those results, undertake further investigation if needed. The use of CT scans has also contributed to a decreased reliance on surgical explorations of renal injuries. While the presence of urinary extravasation (a disrupt with the urethra causing urine to collect in the scrotum or other body cavities) itself does not necessarily indicate that surgical exploration is necessary, it does confirm the presence of a major renal injury.
Most blunt renal trauma can be treated via observation and bed rest. In fact, guidelines suggest a generally noninvasive management approach in stable patient with renal injuries. The structure of the kidney itself lends itself to nonoperative management in that when blunt force causes a laceration, even if the resulting hematoma displaces the renal tissue, the segmental vessels often stay intact allowing the kidney to repair itself. In addition, the kidney is rich in tissue factor, which promotes hemostasis, which stops traumatic blood flow after and injury. This prevents internal bleeding as well as the medical complications it can lead to.
Interventional radiology techniques also allow renal lacerations to be treated nonoperatively; some of these include endourologic stenting, angiography with selective embolization, and percutaneous drainage of perinephric fluid collections or urinomas.
However, penetrating trauma tends to be associated with more severe renal trauma and can require a laparotomy, particularly if it is associated with other abdominal injuries. In that sense, operative therapy offers the advantage of being able to address renal trauma and concurrent injuries at the same time. One study documented 80% of patients with renal lacerations also experienced associated injuries, indicating that an immediate laparotomy is appropriate. A laparotomy is when a small camera is inserted into abdominal cavity through a surgical incision in order to diagnosis internal injuries. A medical professional must operate immediately if the patient has excessive bleeding (i.e. there is a need for hemorrhage control) and/or there is a need for renal tissue preservation. This will sometimes show up as a retroperitoneal hematoma or an avulsion of the main renal artery or vein. Other risk factors which may indicate a need for surgery include a medial renal laceration, intravascular contrast extravasation, or a perirenal hematoma.
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