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.

• Easy Bruising

  In high doses, they commonly cause an increase in appetite and weight, puffiness of the face, and easy bruising. [medicinenet.com]

• Inflammation

  Apoptosis, inflammation, and oxidative stress were analyzed via western blotting, real-time PCR, light microscopy, and immunofluorescence. Results. [ncbi.nlm.nih.gov]

• Sepsis

  This study was aimed to clarify the role of CTXA in modulating renal functional damage in a mouse model of sepsis and to elucidate its underlying mechanisms. [ncbi.nlm.nih.gov]

  Spectrum as classified according to the RIFLE criteria Risk Injury Failure Loss End-stage INCIDENCE + PROGRESSION common (35-65%) of ICU admissions 5-20% general hospital admissions mortality significantly increases in patients with AKI RISK FACTORS sepsis [lifeinthefastlane.com]

  Haemorrhage Burns Reduced cardiac output Pre-renal: inadequate blood supply to the kidneys Acute coronary syndrome (ACS) Cardiac arrhythmia eg atrial fibrillation (AF) Valvular heart disease Hypertension Cardiomyopathy Cardiac tamponade Late sepsis Renal [oxfordmedicaleducation.com]

  Hypotension (eg, cardiogenic shock, sepsis, anaphylaxis). Cardiovascular (eg, severe cardiac failure, arrhythmias). [patient.info]

  Dellinger RP, et al: Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013;41:580-637. Lee JS: Albumin for end-stage liver disease. Korean J Intern Med 2012;27:13-19. [karger.com]

• Congestive Heart Failure

  heart failure, arterial hypotension Nephrotoxic drugs (esp. [amboss.com]

  Commonly associated with sepsis, cardiovascular collapse, congestive heart failure, major surgery, nephrotoxins (such as antibiotics, intravenous contrast, or other drugs), or urinary outflow obstruction. [bestpractice.bmj.com]

  These include decreased blood volume; chronic kidney insufficiency; congestive heart failure; and taking other medications such as diuretics, blood pressure medicines called angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers [fda.gov]

  heart failure, and diuretic use) intrarenal causes acute tubular necrosis ischemia and toxic causes interstitial nephritis glomerulonephritis vasculitis hemolytic uremic syndrome cholesterol emboli postrenal causes Pathogenesis based upcome etiology [medbullets.com]

  Extramuscular organ involvement is described including pulmonary disorders (exertional dyspnea, aspiration, interstitial lung disease (see this term)), and less commonly cardiac involvement (arrhythmia, pericarditis, myocarditis, congestive heart failure [orpha.net]

• Collapse

  The chronic kidney disease is a collapse of the kidney normal functions to eliminate toxins from the human body. It has no cure and the only option currently available is a kidney transplant. [iuf.org]

  Commonly associated with sepsis, cardiovascular collapse, congestive heart failure, major surgery, nephrotoxins (such as antibiotics, intravenous contrast, or other drugs), or urinary outflow obstruction. [bestpractice.bmj.com]

  The main objectives of initial management are to prevent cardiovascular collapse and death and to call for specialist advice from a nephrologist. [en.wikipedia.org]

• Surgical Procedure

  A variety of surgical procedures were used to repair the defect, depending on the location and severity of the defect. Complications occurred in 24 patients. [east.org]

• Vomiting

  […] 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]

  […] to their worst criterion Epidemiology of acute kidney injury Common Often accompanies other acute medical or surgical problems due to its wide range of causes Causes of acute kidney injury (AKI) Hypovolaemia Inadequate fluid intake Excess fluid loss Vomiting [oxfordmedicaleducation.com]

  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]

  Aetiology [ 4 ] The majority of AKI developing in the community is due to a pre-renal state (90% cases), typically hypotension associated with sepsis and/or fluid depletion (eg, vomiting or diarrhoea). [patient.info]

  Further, abruptly stopping corticosteroids can cause flares of the disease and result in other side effects, including nausea, vomiting, and decreased blood pressure. Corticosteroids do not always adequately improve polymyositis. [medicinenet.com]

• Heart Failure

  Abstract Tolvaptan (TLV) is a new vasopressin type 2 receptor antagonist effective in patients with heart failure (HF). We herein describe the case of an 84-year-old woman who developed acute renal injury induced by hypersensitivity to TLV. [ncbi.nlm.nih.gov]

  The combination of NSAIDs with diuretics alone has been shown to double the risk of hospitalization in patients with heart failure. [todaysgeriatricmedicine.com]

  This may mean treating a health problem like heart failure, taking you off certain medications, or giving you fluids through an IV if you’re dehydrated. Medications. [webmd.com]

• Heart Disease

  Decreased blood flow to the kidney, such as from hypercalcemia (high blood calcium level) or severe heart disease A disease or condition that affects the kidneys, such as hypertension (high blood pressure) or diabetes A blockage in the kidney or ureter [drugs.com]

  It is important that AKI is found as soon as possible because it can lead to chronic kidney disease, or even kidney failure. It may also lead to heart disease or death. [kidney.org]

  Untreated, type 2 diabetes can lead to serious problems, including blindness, nerve and kidney damage, and heart disease. [fda.gov]

  Possible Complications Complications may include: Calcium deposits in the affected muscles, especially in children with the disease Cancer Heart disease, lung disease, or abdominal complications When to Contact a Medical Professional Call your health [pennstatehershey.adam.com]

  disease Hypertension Cardiomyopathy Cardiac tamponade Late sepsis Renal artery disease Renal artery stenosis Vasculitis Intrinsic renal: direct damage to the kidneys Glomerular Proliferative glomerulonephritis Typically presents as nephritic syndrome [oxfordmedicaleducation.com]

• Sweating

  This condition is attended with rheumatoid pains, stiffness and tumefaction of the extremities, febrile movement, firm edema, especially of the face, redness of the skin, impaired mobility, excessive sweating and enlargement of the spleen. [jamanetwork.com]

  They can also cause sweats, facial-hair growth, upset stomach, sensitive emotions, leg swelling, acne, cataracts, osteoporosis, high blood pressure, worsening of diabetes, and increased risk of infection. [medicinenet.com]

  […] dyspnoea progressing from an exercise tolerance of dyspnoea on exertion to at rest Orthopnoea PND Cough productive of pink, frothy sputum Ankle swelling Symptoms of sepsis Fever Rigors Symptoms of the focus Symptoms of malignancy Cachexia Anorexia Night sweats [oxfordmedicaleducation.com]

  Abdominal pain and swelling Severe flank pain and back pain Blood in the urine Drowsiness, decreased alertness, including coma Decreased urine output or inability to urinate Fever Increased heart rate Nausea, vomiting Skin that is pale or cool to touch Sweating [medlineplus.gov]

  Abdominal compartment syndrome Hypercalcemia Systemic vasodilation (e.g., sepsis,* neurogenic shock) Volume depletion Renal loss from diuretic overuse,* osmotic diuresis (e.g., diabetic ketoacidosis*) Extrarenal loss from vomiting, diarrhea,* burns, sweating [aafp.org]

• 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. [msdmanuals.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]

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.