Presentation
More than 70 acute pediatric presentations are covered in a signs and symptoms section designed with side tabs for easy access. [books.google.com]
Case presentation: A 31 year old previously healthy primigravida presented to the Emergency Department complaining of severe left flank pain. [omicsonline.org]
The patient presented anemization and increased pain, requiring selective embolization by means of arteriography of a branch of the right renal artery and placement of a double J stent due to urinary extravasation in the lower left kidney pole. [karger.com]
Patients tend to present with microscopic or macroscopic hematuria and flank and/or abdominal pain. In more severe cases, hypotension and shock may be present. [radiopaedia.org]
The traumatic rupture of cyst presents as emergency mimmiking any of the abdominal emergencies, but this has to be suspected in an undiagnosed case and thoroughly investigated before contemplating on treatment acute abdomen. [ispub.com]
Entire Body System
- Swelling
The spleen can also swell to irritate the stomach and the main complaint might be indigestion. [mddirect.org]
Aspiration to remove pooled blood and swelling Urinalysis CBC (complete blood count) CT scan (Computed Tomography) Diagnostic Ultrasound Current practice recommendations state that all children with blunt trauma and hematuria should be imaged regardless [ksi.uconn.edu]
Bladder rupture leads to severe pain in the hypogastrium on palpation or swelling from extravasation of blood and urine in the suprapubic area. [medical-dictionary.thefreedictionary.com]
Signs and symptoms of acute kidney injury differ depending on the cause and may include: Too little urine leaving the body Swelling in legs, ankles, and around the eyes Fatigue or tiredness Shortness of breath Confusion Nausea Seizures or coma in severe [kidney.org]
[…] life-threatening hemorrhage and renal ischemia ASSESSMENT Clinically significant injuries will have at least one of: Macroscopic haematuria (About 5% of renal injuries and up to 20% of renovascular injuries lack even microscopic hematuria) Loin tenderness and/ or swelling [lifeinthefastlane.com]
- Surgical Procedure
Short-term stenting, ranging from weeks to months, may be placed during an open surgical procedure of the urinary tract to provide a mold around which healing can occur, or to divert the urinary flow away from areas of leakage. [ucsfhealth.org]
As described by Huang et al. in pregnant women with pre-existing hydronephrosis, actions associated with sudden increase of the hydrostatic pressure in the urinary tract, like IV fluid boluses for pregnancy related surgical procedures (i.e. placement [omicsonline.org]
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]
Gastrointestinal
- Abdominal Tenderness
tenderness Flank contusions Lower rib fractures Patients who develop gross hematuria after relatively minor trauma may have a previously undiagnosed congenital renal anomaly. [merckmanuals.com]
Testicular Injuries Testicular injuries often occur due to a traumatic blow to the groin or scrotum, which can cause severe pain, nausea, vomiting and in some instances, lower abdominal tenderness. [ucsfhealth.org]
Signs and Symptoms of Renal Trauma Acute signs and symptoms: History of abdominal trauma or deceleration injury Bruising and hematoma of abdomen or flank Abdominal tenderness and tumor Flank pain Rib fracture Hematuria Hemodynamic instability, Shock Late [urology-textbook.com]
- Left Flank Pain
Case presentation: A 31 year old previously healthy primigravida presented to the Emergency Department complaining of severe left flank pain. [omicsonline.org]
Cardiovascular
- Hypertension
The symptoms are hypertension predates renal failure, Infections, hemorrhage, and renal calculus, massive intracystic or retroperitoneal hemorrhage can occur; these require nephrectomy. [ispub.com]
Hypertension Renal trauma patients are at risk for later development of hypertension (Page kidney). [clinicaladvisor.com]
Complications Complications affect ~7.5% (range 3-10%) of renal injuries 4,5 : urinoma (most common) delayed bleeding (within 1-2 weeks of injury) urinary fistula perinephric abscess hypertension from renal artery injury hydronephrosis pyelonephritis [radiopaedia.org]
As well, hypertension may occur transiently because the kidney houses hormones and chemicals that help control blood pressure. [medicinenet.com]
But we did not performe total nephrectomy of the left kidney, because renal hypertension in this case was not manifested. The patient is strictly followed up on an ambulant basis. [ci.nii.ac.jp]
- Thrombosis
[…] hematoma Subcapsular / perinephric hematoma usually proportional to extent of injury Wedge-shaped perfusion defect = segmental arterial injury Diffuse non-perfusion of kidney = devascularized kidney Persistent nephrogram on delayed scans = renal vein thrombosis [learningradiology.com]
The spectrum of renal injuries include: contusion/hematoma laceration hemorrhage avulsion of the renal pedicle leading to devascularisation of the kidney pseudoaneurysm AV fistula renal artery thrombosis, transection or dissection (see article: acute [radiopaedia.org]
[…] nonexpanding retroperitoneal hematoma Grade 3: Laceration > 1 cm sparing the collecting system Grade 4: Laceration > 1 cm involving the collecting system and/or renal vessel injury with contained hemorrhage Grade 5: Shattered kidney and/or renal artery thrombosis [merckmanuals.com]
Kidneys may be injured by damage to the blood vessels that supply or drain them, including: Aneurysm Arterial blockage Arteriovenous fistula Renal vein thrombosis (clotting) Trauma Kidney injuries may also be caused by: Angiomyolipoma, a noncancerous [medlineplus.gov]
Trauma may lead to hematuria, hemorrhage, thrombosis, renal artery occlusion or destruction, and tissue disruption of parenchyma and collecting ducts. Children are more susceptible to renal trauma due to anatomical variations from adults. [sjosm.org]
Skin
- Grey Turner's Sign
Inspect the lower back and flank for Grey-Turner’s sign or bruising because of a retroperitoneal hemorrhage. Note any abdominal distention. To identify lower urinary tract trauma, inspect the urinary meatus to determine the presence of blood. [medical-dictionary.thefreedictionary.com]
Psychiatrical
- Suggestibility
The trauma conditions, an excesive clinic manifestation, a clinical investigation about known congenital simultaneous anomallies and typical radiological signs, can suggest this infrequent patology. [ncbi.nlm.nih.gov]
Obtain contrast-enhanced CT for suspected moderate or severe injury (eg, mechanism or findings suggesting severe injury, gross hematuria, hypotension). [merckmanuals.com]
Diagnosis is suggested by the presence of massive medial extravasation of contrast material at excretory urography or computed tomography. Surgical treatment consists in pyeloplasty or pyeloraphy with stent placement (double J) or nephrostomy. [ingentaconnect.com]
The results suggest progress in the triage of patients with urogenital injuries. [east.org]
That being said, a retrospective study suggests that primary conservative treatment of blunt kidney rupture seems to lead to less surgery, especially less open surgery, and less blood and renal parenchyma loss, compared to a strategy of initial surgery [en.wikipedia.org]
Neurologic
- Forgetful
Blunt injury to the ureter is so rare it’s reportable, so you can pretty much forget that one unless the mechanism is extreme. So you really just need to focus on kidney and bladder. [regionstraumapro.com]
Urogenital
- Hematuria
25% of patients with gross hematuria have significant injuries But, 24% of patients with renal pedicle injury have no hematuria Only 1-2% with microhematuria have a severe renal injury Types of injuries CT Classification of Renal Trauma CT Grade Injury [learningradiology.com]
Evaluation of Hematuria in Blunt Trauma Hematuria ranges from microscopic to gross. Microscopic means blood that can only be seen with a microscope, and gross means visible to the naked eye. [regionstraumapro.com]
Patients require strict bed rest until gross hematuria has resolved. [merckmanuals.com]
Hematuria. The incidence of gross hematuria varies widely, in anywhere from 24%-88% of pediatric renal patients, while microscopic hematuria increases that number to greater than 90%. [clinicaladvisor.com]
The lack of hematuria does not exclude severe renal trauma. [urology-textbook.com]
- Renal Injury
[…] of the AAST classification of renal injuries. [radiopaedia.org]
Renal injuries are classified according to severity into 5 grades (see Figure: Grades of renal injury. ). Grades of renal injury. [merckmanuals.com]
In patients with severe bilateral injuries, severe injuries to or obstruction of a solitary kidney, or with injuries in a patient with baseline renal insufficiency, renal injury may reflect a primary effect of trauma on the renal parenchyma. [clinicaladvisor.com]
In rural settings, 90-95% of renal injuries are comprised of blunt trauma injuries, where in urban settings 40% of renal injuries are comprised of penetrating injuries. [austinpublishinggroup.com]
- Flank Pain
Hematuria was the most frequent manifestation (21 patients [84%]), followed by flank pain (17 patients [68%]). [ncbi.nlm.nih.gov]
Acute hydronephrosis is one of the most common causes of severe flank pain in pregnancy. Severe complications of hydronephrosis of pregnancy, such as pain. renal failure or a ruptured collecting system. occur very occasionally. [doi.org]
Keywords Ultrasound FAST Trauma Renal cyst rupture Emergency Case report A 79-year-old man presented to the emergency department complaining of right flank pain after falling down two stairs. [criticalultrasoundjournal.springeropen.com]
Keywords Hydronephrosis; Spontaneous urinary tract rupture; Renal colic; Flank pain pregnancy; Nephrostomy; Kidney; Ureter Background Loin/flank pain in pregnancy is a common presentation to the Emergency Department (ED). [omicsonline.org]
Fever, dropping blood count or flank pain are indications for repeated imaging (ultrasonography or CT). [urology-textbook.com]
- Microscopic Hematuria
Patients with blunt trauma and microscopic hematuria usually have minor renal injuries that almost never require surgical repair; thus, CT is usually unnecessary. [merckmanuals.com]
Renal pedicle injury can lead to life-threatening hemorrhage and renal ischemia ASSESSMENT Clinically significant injuries will have at least one of: Macroscopic haematuria (About 5% of renal injuries and up to 20% of renovascular injuries lack even microscopic [lifeinthefastlane.com]
Diagnosis [ edit ] In blunt injury, imaging is indicated if there is gross hematuria, or if the patient exhibits shock together with either gross or microscopic hematuria. [en.wikipedia.org]
Hematuria. The incidence of gross hematuria varies widely, in anywhere from 24%-88% of pediatric renal patients, while microscopic hematuria increases that number to greater than 90%. [clinicaladvisor.com]
On the whole, patients with blunt abdominal trauma who have gross hematuria, microscopic hematuria with shock, or microscopic hematuria with flank bruising and lower rib or lumbar vertebral transverse process fracture should undergo imaging. [urotoday.com]
- Macroscopic Hematuria
Patients tend to present with microscopic or macroscopic hematuria and flank and/or abdominal pain. In more severe cases, hypotension and shock may be present. [radiopaedia.org]
Gunshot in 86% and stab wound in 14%. 74% had macroscopic hematuria on presentation, 18% with microscopic hematuria, and 8% without hematuria on urinalysis. [east.org]
Workup
[…] segmental arterial thrombosis, pedicle injuries, or disruption of the UPJ can even occur without hematuria in 10% of cases. [29], [30] Hematuria with positive history of blunt abdominal trauma is highly indicative for renal injury and further radiological workup [sjosm.org]
Treatment
Kidney Injuries Treatment for kidney injuries depends on the type and severity of the injury, and whether the patient has any other injuries. [ucsfhealth.org]
The conservative treatment for major renal treatment is appropriate when the patient is thermodynamically stable, but a strict follow up is necessary to reduce the complications. [austinpublishinggroup.com]
However, if treatment is delayed or the kidney sustains serious damage, the kidneys may stop functioning correctly. If this happens, toxins can build up in the blood. [kansascityaccidentinjuryattorneys.com]
Treatment and prognosis Treatment depends on the specific trauma and complications present. [radiopaedia.org]
Treatment: Seek medical attention immediately. [sportsinjuryclinic.net]
Prognosis
Treatment and prognosis Treatment depends on the specific trauma and complications present. [radiopaedia.org]
The overall prognosis for people with chronic renal failure is guarded, and depends on the complexity of their situation; it is not without risks and complications. [traumasurvivorsnetwork.org]
No contrast blush or hemoperitoneum Because of the absence of hemoperitoneum or active bleeding, this patient has a good prognosis and will be managed non-operatively. Splenic injury. [radiologyassistant.nl]
[…] exploration finding are used for the classification of renal injury, according to the system of the American Association for the Surgery of Trauma (AAST) [Table 1]. [20] It is a validated classification scale for renal injuries to help in predicting the prognosis [sjosm.org]
Renal vein injuries have a better prognosis. Nephrectomy should remain treatment of choice in unstable patients with multi-system trauma. 3 Ureteral and renal pelvic injuries from external trauma: diagnosis and management. Presti, Joseph C. [east.org]
Etiology
Etiology Blunt trauma from motor vehicle collisions, falls, and personal collisions are the leading cause of renal injury (~85%), the mechanism is from deceleration injuries from a collision of the kidney with the vertebral column or thoracic cage. [radiopaedia.org]
Etiology of Injuries of the Upper Urinary Tract Penetrating Injuries: Gunshot or stab wounds. Blunt Trauma: Direct blunt force (contusion, bruising of the abdomen or flank) leads to a rupture the kidneys. [urology-textbook.com]
This narrative review article presents an overview of the current knowledge of sport-related renal trauma among children after review of 56 research paper focusing on etiology, pathophysiology, diagnosis, safety measures, and treatment. [sjosm.org]
Meta-analysis of 20 studies showed that overall, 29% of patients with urinary extravasation underwent ureteral stenting. [5] Etiology The mechanism of injury should alert the clinician to the possibility of renal trauma. [emedicine.medscape.com]
[…] crashes alone account for 2 to 10 times more renal injury than sport. 9 The discussion should include an explanation of potential dialysis treatments, transplant, and the need for lifelong medication should the single kidney be lost regardless of the etiology [pediatrics.aappublications.org]
Epidemiology
Epidemiology of renal trauma: In blunt abdominal trauma, up to 40% present with renal injury. In urban areas, 80% of renal injuries occur in the context of polytrauma. In ski resorts, 2/3 of renal injuries are due to skiing accidents. [urology-textbook.com]
Epidemiology Frequency The frequency of renal injury somewhat depends on the patient population being considered. Renal trauma accounts for approximately 3% of all trauma admissions and as many as 10% of patients who sustain abdominal trauma. [emedicine.medscape.com]
Background and Epidemiology Trauma refers to injury caused by external force from a variety of mechanisms, including traffic- or transportation-related injuries, falls, assault (e.g., blunt weapon, stabbing, gunshot), explosions, etc. [auanet.org]
Epidemiology Genitourinary tract injuries can be identified in 8-10% of the patients with abdominal blunt trauma and in about 6% of penetrating trauma patients 6, 7. [ncbi.nlm.nih.gov]
Pathophysiology
This narrative review article presents an overview of the current knowledge of sport-related renal trauma among children after review of 56 research paper focusing on etiology, pathophysiology, diagnosis, safety measures, and treatment. [sjosm.org]
Prevention
It is important to keep an eye on fluid intake to prevent the body from having too much. Medication is sometimes used to prevent changes in the biochemistry of the blood. [traumasurvivorsnetwork.org]
"Our data hasn't informed prevention strategies yet," said Breyer. Although changes in a bicycle's design could potentially prevent some injuries, "you can't figure that out with this kind of study," he said. [foxnews.com]
Kidney failure has been identified by the Centers for Disease Control and Prevention as one of the most urgent public health concerns in Haiti following the 7.0-magnitude earthquake. [cnn.com]
The many layers of padding help prevent kidney injury. [medlineplus.gov]
Early intervention can prevent many of the complications that can result from an injury to the kidneys. Treatment for a mild injury that is caught early may involve bed rest in the hospital with regular testing of blood and urine. [kansascityaccidentinjuryattorneys.com]