Microscopic or gross hematuria may be encountered in patients with low-grade injury, while signs of hypovolemic shock (hypotension, weakness, loss of consciousness) may be the only symptoms in the setting of life-threatening hemorrhage as a result of severe kidney damage.

• Pain

  This case report describes a 25-year-old with degenerative lumbar scoliosis who presented with flank pain and visible haematuria following a low-impact injury. The patient had a grade IV renal injury. [ncbi.nlm.nih.gov]

  […] and vomiting, abdominal pain / back pain 7.7 Within normal limits Increased cortical echogenicity Mr. [cdc.gov]

  Symptoms of bladder obstruction Complete Painful suprapubic mass Anuria Partial Painful suprapubic mass Urinary frequency Hesitancy Poor stream Terminal dribbling Strangury Drug history Angiotensin converting enzyme inhibitors (ACEIs) Angiotensin receptors [oxfordmedicaleducation.com]

  Try to: Pay attention to labels when taking over-the-counter (OTC) pain medications. [mayoclinic.org]

  “We hypothesized that we were going to say ibuprofen is safe,” said Lipman, an endurance runner himself who regularly used the pain reliever during races. “We thought we’d be able to say ‘Go forth and run and have no pain.’ [med.stanford.edu]

• Falling

  Seen in approximately 1-5% of all traumas, a renal injury is a broad term encompassing damage of the kidneys most frequently caused by blunt trauma (motor vehicle accidents, contact sports, fall from height) or penetrating trauma. [symptoma.com]

  Case one was an 18 year-old boy who had a fall when riding a motorbike at 20 km/h with a helmet and full protective equipments. He was landed by his left flank onto a rock. [ncbi.nlm.nih.gov]

  VİDEO SUNUMU: A 15 year old male patient was hospitalized 5 hours after falling down stairs. Abdominal CT with contrast demonstrated right cross ectopic fused kidney with grade 4 laseration and severe perirenal hematoma. [bildirim.org]

  For children the pRIFLE, stages 1 (risk), 2 (injury) and 3 (failure), are defined at specific falling levels of eGFR and falling urinary output [ 5 ]. [patient.info]

  Most renal injuries (85 to 90% of cases) result from blunt trauma, typically due to motor vehicle crashes, falls, or assaults. Most injuries are low grade. [merckmanuals.com]

• Weakness

  Symptoms The gradual onset of weakness over weeks or months Difficulty rising from a low-seated chair or combing one’s hair Torso or “core” weakness Difficulty swallowing (dysphagia) Pain or weakness in the joints Generalized fatigue Diagnostic Tests [hopkinsmyositis.org]

  These symptoms may come and go: Muscle weakness: This is the most common symptom. [my.clevelandclinic.org]

  Microscopic or gross hematuria may be encountered in patients with low-grade injury, while signs of hypovolemic shock (hypotension, weakness, loss of consciousness) may be the only symptoms in the setting of life-threatening hemorrhage as a result of [symptoma.com]

  Muscle weakness and tenderness can be signs of polymyositis. A rash is a sign of a related condition, dermatomyositis. Common symptoms include: Muscle weakness in the shoulders and hips. [pennstatehershey.adam.com]

  The weakness affects both the left and right sides of your body, and tends to gradually worsen. When to see a doctor Seek medical attention if you develop unexplained muscle weakness. [mayoclinic.org]

• Fever

  We reported a patient who presented with fever hemoptysis from diffuse pulmonary hemorrhage, and acute renal injury. Renal biopsy revealed IgAN concomitant with AIN which was the cause of renal dysfunction. [ncbi.nlm.nih.gov]

  They depend on the underlying cause, but some of the most common symptoms include: hemorrhage (heavy bleeding) fever rash bloody diarrhea severe vomiting abdominal pain no urine output or high urine output pale skin edema (swelling of the tissues) swelling [childrenshospital.org]

  Fever. Weight loss. Get useful, helpful and relevant health + wellness information enews More health news + advice [my.clevelandclinic.org]

  In about one-third of cases, there is a history of maculopapular erythematous rash, fever, arthralgias, or a combination of these symptoms. 13 Eosinophiluria may be found in patients with acute interstitial nephritis, but it is not pathognomonic of this [aafp.org]

  […] severe depending on rupture Muscle guarding Low back pain Abdominal bruising, swelling, and pain Signs of internal bleeding: decreased alertness, dizziness, fatigue, blurred vision, low BP, nausea, vomiting Decreased urine output or inability to urinate Fever [ksi.uconn.edu]

• Anemia

  Stx-2 induced weight loss, anemia, and thrombocytopenia and increased serum creatinine, free serum hemoglobin, and cystatin C levels, but a significantly decreased glomerular filtration rate compared with control/sham mice. [ncbi.nlm.nih.gov]

  Hematologic Complications Anemia develops rapidly in AKI and is usually multifactorial in origin. [renalandurologynews.com]

  […] leads to anemia and small kidney size. [en.wikipedia.org]

  […] responding to medical treatment should be dialyzed a patient with a history of excessive fluid loss ( e.g., diarrhea and vomiting) should be given intravenous fluid Complications Hyperkalemia Metabolic acidosis Uremic encephalopathy and platelet dysfunction Anemia [medbullets.com]

  Supportive therapies (e.g., antibiotics, maintenance of adequate nutrition, mechanical ventilation, glycemic control, anemia management) should be pursued based on standard management practices. [aafp.org]

• Acute Abdomen

  abdomen, and denervated abdomens with penetrating abdominal injuries. [east.org]

• Tachycardia

  Postural hypotension Absolute hypotension Dark urine Signs of cardiac failure Respiratory distress Tachypnoea Bibasal crepitations Cardiac wheeze Tachycardia Displaced apex beat Third heart sound RV heave Raised JVP Hepatomegaly Peripheral oedema Signs [oxfordmedicaleducation.com]

  Other signs and symptoms may include orthostatic hypotension and tachycardia. [todaysgeriatricmedicine.com]

  […] for Categorizing Acute Kidney Injury Type of acute kidney injury History findings Physical examination findings Prerenal Volume loss (e.g., history of vomiting, diarrhea, diuretic overuse, hemorrhage, burns) Weight loss, orthostatic hypotension and tachycardia [aafp.org]

  Although related to delta-9-tetrahydrocannabinol, the active ingredient in marijuana, SCs are two to three times more likely to be associated with sympathomimetic effects (i.e., tachycardia and hypertension), and approximately five times more likely to [cdc.gov]

  Back to Top Table 3 Heart injury scale Grade Description of injury ICD-9 AIS-90 I Blunt cardiac injury with minor ECG abnormality (nonspecific ST or T wave changes, premature arterial or ventricular contraction or persistent sinus tachycardia) 861.01 [aast.org]

• Contusion

  Back to Top Table 4 Lung Injury Scale Grade* Injury Type Description of Injury ICD-9 AIS-90 I Contusion Unilateral, 861.12 3 861.31 II Contusion Unilateral, single lobe 861.20 3 861.30 Laceration Simple pneumothorax 860.0/1 3 III Contusion Unilateral, [aast.org]

  The prognosis directly depends on the severity of kidney damage and the classification of renal injury is as follows: Stage I - Characterized by contusion or the presence of a nonexpanding subcapsular hematoma, this form accounts for 80% of cases. [symptoma.com]

  About 10-15 percent of all blunt abdominal trauma is associated with blunt renal injury; 85 percent of these renal injuries are minor contusions and can successfully be treated conservatively. [ncbi.nlm.nih.gov]

  Grade II Deep corticomedullary laceration involving the collecting system Observation or surgery Grade III Renal crush injury and/or main vascular pedicle injury Surgery Grade IV Injury of the renal pelvis or the ureteropelvic junction Surgery Renal contusion [learningradiology.com]

  While isolated contusion is self-limited, it is frequently seen in the context of more sever renal injuries. [med-ed.virginia.edu]

• Fracture

  Renal Trauma Renal Fracture and Renal Laceration Incidence Up to 10% of injuries coming to emergency room with blunt trauma Causes Motor vehicle accident Contact sports Falls and fights Less often penetrating wounds Mechanism Direct blow (>80%) frequently [learningradiology.com]

  Delayed CT images following contrast show a fractured right kidney and extravasation of urine (U) into perinephric space in this patient s/p severe blunt trauma from MVC. [med-ed.virginia.edu]

  Injuries of the renal vessels causing hemorrhage and devascularization of renal segments, as well as multiple lacerations involving the renal cortex, medulla, and the collecting system are predominant findings while expanding subcapsular hematomas and fractured [symptoma.com]

  Kidney damage; Toxic injury of the kidney; Kidney injury; Traumatic injury of the kidney; Fractured kidney; Inflammatory injury of the kidney; Bruised kidney; Ureteral injury; Pre-renal failure - injury; Post-renal failure - injury; Kidney obstruction [medlineplus.gov]

  ( > 3 ribs) Fracture Bilateral flail chest ( > 3 ribs on both sides) 807.4 3-4 V Fracture 807.4 5 *This scale is confined to the chest wall alone and does not reflect associated internal or abdominal injuries. [aast.org]

• Dizziness

  […] blood in urine) is the most common presenting sign of renal injury Right or left abdominal pain, mild or severe depending on rupture Muscle guarding Low back pain Abdominal bruising, swelling, and pain Signs of internal bleeding: decreased alertness, dizziness [ksi.uconn.edu]

  This can result in: Feeling tired or weak Memory problems Difficulty concentrating Dizziness Low blood pressure Normally proteins are too large to pass through the kidneys. However they are able to pass through when the glomeruli are damaged. [en.wikipedia.org]

• Irritability

  All patients had hematuria, 47.3% gross, 18.8% shock, 82.9% flank pain, 30.5% peritoneal irritation.39 patients received "normal dose IVU, 44 "double dose IVU, 109 had US, and 45 patients underwent CT. [east.org]

• Paresis

  Immunology: Serum immunoglobulins, serum protein electrophoresis, Bence Jones' proteinuria: immune paresis, monoclonal band on serum protein electrophoresis, and Bence Jones' proteinuria suggest myeloma. [patient.info]

• Renal Injury

  Results: A total of 130 Chinese patients with acute renal injury and 130 Chinese individuals with no clinical symptoms of acute renal injury were included. [ncbi.nlm.nih.gov]

  Renal injury is a broad term that encompasses various forms of kidney injury caused by trauma. [symptoma.com]

• Hematuria

  The clinical manifestations in IgAN can be asymptomatic microscopic hematuria, gross hematuria, nephritic syndrome, nephrotic syndrome or acute renal injury from crescentic glomerulonephritis. [ncbi.nlm.nih.gov]

  Microscopic or gross hematuria may be encountered in patients with low-grade injury, while signs of hypovolemic shock (hypotension, weakness, loss of consciousness) may be the only symptoms in the setting of life-threatening hemorrhage as a result of [symptoma.com]

  Patients should be maintained on strict bed rest until the gross hematuria has resolved. [merckmanuals.com]

  We report here a case of exercise-induced hematuria presenting as gross hematuria lasting 1 week in a 19-year-old male patient. Gross hematuria developed after strenuous exercise about 3 years ago. [ekjm.org]

• Kidney Failure

  Work with your doctor to manage existing medical conditions that could lead to acute kidney failure. Acute kidney failure can be a life-threatening illness. Chronic renal failure or end-stage renal disease can develop. [healthline.com]

  Acute kidney failure — also called acute renal failure or acute kidney injury — develops rapidly, usually in less than a few days. [mayoclinic.org]

  A decrease in kidney function that happens over time is called chronic kidney failure. When your kidneys stop working suddenly, you have what doctors call acute kidney failure (or acute renal failure). It can happen over just a few hours or days. [webmd.com]

  Acute-on-chronic kidney failure [ edit ] Acute kidney injuries can be present on top of chronic kidney disease, a condition called acute-on-chronic kidney failure (AoCRF). [en.wikipedia.org]

• Microscopic Hematuria

  The clinical manifestations in IgAN can be asymptomatic microscopic hematuria, gross hematuria, nephritic syndrome, nephrotic syndrome or acute renal injury from crescentic glomerulonephritis. [ncbi.nlm.nih.gov]

  With penetrating trauma to the abdomen and lower chest, CT is indicated in all patients with microscopic or gross hematuria. [merckmanuals.com]

  Microscopic or gross hematuria may be encountered in patients with low-grade injury, while signs of hypovolemic shock (hypotension, weakness, loss of consciousness) may be the only symptoms in the setting of life-threatening hemorrhage as a result of [symptoma.com]

• Flank Pain

  This case report describes a 25-year-old with degenerative lumbar scoliosis who presented with flank pain and visible haematuria following a low-impact injury. The patient had a grade IV renal injury. [ncbi.nlm.nih.gov]

  May present with flank pain, haematuria, hypertension or hypotension, oedema, lethargy, uraemia, or decreased urine output; however, often asymptomatic and only diagnosed by laboratory tests. [bestpractice.bmj.com]

  […] and vomiting, flank pain 6.3 WBCs, RBCs, epithelial casts, granular casts Not available Blueberry-flavored 4 Wyoming 18 Nausea and vomiting, flank pain 4.1 Hyaline casts, WBCs No increased cortical echogenicity or hydronephrosis Blueberry-flavored or [cdc.gov]

  As AKI progresses, you may have any of the following: Decrease in the amount of urine or no urination Swelling in your arms, legs, or feet Weakness, drowsiness, or no appetite Nausea, flank pain, muscle twitching or muscle cramps Itchy skin, or your breath [drugs.com]

  Pain in the back just below the rib cage. This is called flank pain. Some people may not have any symptoms. And for people who are already quite ill, the problem that's causing the kidney injury may be causing other symptoms. [cigna.com]

In order to obtain information regarding the cause of trauma and assess basic vital functions, a detailed patient history, and a thorough physical examination is crucial. Imaging studies, however, are needed to confirm the diagnosis and determine the extent of the injury. MDCT is the method of choice, as ultrasonography, magnetic resonance imaging, intravenous pyelogram and arteriography provide inferior results and may be useful in evaluating only specific areas of interest (blood vessels, ureters or the ureteropelvic junction and the renal pelvis) [1] [3].

Blood pressure control, ensuring adequate respiration and oxygen saturation, as well as transfusions (both whole red blood cell and fresh frozen plasma) in the setting of hypovolemic shock, are some of the main conservative measures employed in the setting of renal injury and they may be sufficient in patients who experience as high as stage IV injury [1]. Surgical exploration, vascular repair through angioembolization, salvage of the remaining kidney tissue and nephrectomy, on the other hand, are indicated in the setting of life-threatening hemorrhage and extensive trauma (stage V) [1] [6]. Urinary extravasation and the formation of urinomas, hypertension, renal failure, infection, and sepsis are possible complications of renal trauma [1], implying that early recognition and timely initiation of treatment is imperative.

The prognosis directly depends on the severity of kidney damage and the classification of renal injury is as follows [2] [4] [5]:

• Stage I - Characterized by contusion or the presence of a nonexpanding subcapsular hematoma, this form accounts for 80% of cases.
• Stage II - A nonexpanding perinephric hematoma confined to the retroperitoneum or the presence of a cortical laceration with a depth of < 1 cm that preserves the collecting system are the main features.
• Stage III - Apart from the laceration depth of > 1 cm, stage III is similar to stage II.
• Stage IV - Injuries of the renal vessels causing hemorrhage and devascularization of renal segments, as well as multiple lacerations involving the renal cortex, medulla, and the collecting system are predominant findings while expanding subcapsular hematomas and fractured kidneys also belong to stage IV.
• Stage V - Avulsion of the ureteropelvic junction that leads to complete kidney devascularization and a shattered kidney are hallmarks of the most severe clinical stage.

Based on the mechanism of injury, blunt or penetrating trauma are described as causes [1]. Motor vehicle accidents, contact sports (eg. martial arts), or fall from height are most common forms of blunt trauma [1], while gunshot and stabbing wounds are main examples of penetrating trauma, which is much rarely encountered in clinical practice [4].

Compared to splenic or liver damage, a renal injury is a less commonly encountered as a part of abdominal trauma and is established to occur in 1-5% of cases [1]. Penetrating forms of injury are predominantly seen in males [4].

Mechanical trauma to the renal parenchyma is the main event in kidney injury and the severity of trauma directly influences the extent of damage [2].

Having in mind the fact that kidney injury most likely occurs accidentally, early recognition of the condition may significantly improve the outcome and thus represent an important strategy in reducing mortality rates.

Seen in approximately 1-5% of all traumas, a renal injury is a broad term encompassing damage of the kidneys most frequently caused by blunt trauma (motor vehicle accidents, contact sports, fall from height) or penetrating trauma [1]. The clinical presentation depends on the severity of the injury, and stages from I (contusion, microscopic hematuria, normal urinalysis) to V (completely shattered kidney with devascularization) are described, but milder forms are seen in approximately 95% of cases [2] [3]. Multidetector computed tomography (MDCT) is the recommended diagnostic method in assessing renal injury [3]. A detailed multidisciplinary approach is necessary when deciding on optimal therapy, as the presence of other organ trauma (most commonly the spleen and the liver), and the potential development of numerous complications (hypovolemic shock, infection, hemorrhage, renal failure) may significantly complicate the clinical course [1] [3].

Renal injury is a broad term that encompasses various forms of kidney injury caused by trauma. Motor vehicle accident, falls from height and injury during contact sports (such as martial arts) are main modes of "blunt" trauma that may present with no external evidence of injury, whereas gunshot and stabbing wounds (also known as penetrating trauma) may also cause significant damage to the kidney. Depending on the severity of injury, symptoms may range from microscopic or gross appearance of blood in urine (hematuria) to life-threatening shock manifesting as hypotension, loss of consciousness and weakness, which is why early recognition of kidney injury is imperative. To assess the extent of damage and decide on optimal therapy, computed tomography should be performed, but only after a thorough physical examination that will make a presumptive diagnosis and evaluate whether additional organs may be damaged. For milder injuries, conservative measures consisting of blood pressure management and breathing control, together with blood transfusions may be sufficient, while surgery to repair damage and prevent complications (infection, leakage of urine, bleeding, kidney failure) may be necessary in more severe kidney damage.

1. Shoobridge JJ, Corcoran NM, Martin KA, Koukounaras J, Royce PL, Bultitude MF. Contemporary Management of Renal Trauma. Rev Urol. 2011;13(2):65-72.
2. Santucci RA, Wessells H, Bartsch G, et al. Evaluation and management of renal injuries: consensus statement of the renal trauma subcommittee. BJU Int. 2004;93:937–954.
3. Dayal M, Gamanagatti S, Kumar A. Imaging in renal trauma. World J Radiol. 2013;5(8):275-284.
4. Kansas BT, Eddy MJ, Mydlo JH, Uzzo RG. Incidence and management of penetrating renal trauma in patients with multiorgan injury: extended experience at an inner city trauma center. J Urol. 2004;172(4 Pt 1):1355-1360.
5. Tasian GE, Aaronson DS, McAninch JW. Evaluation of renal function after major renal injury: correlation with the American Association for the Surgery of Trauma Injury Scale. J Urol. 2010;183(1):196-200.
6. Prasad NH, Devraj R, Chandriah GR, Sagar SV, Reddy CR, Murthy PVLN. Predictors of nephrectomy in high grade blunt renal trauma patients treated primarily with conservative intent. Indian J Urol. 2014;30(2):158-160.