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2.1
Traumatic Rupture of the Kidney
Traumatic Rupture of Kidney

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

  • Sepsis

    Some examples include: A type of severe, life-threatening infection called “sepsis” A type of cancer called “multiple myeloma” A rare condition that causes inflammation and scarring to your blood vessels, making them stiff, weak, and narrow (called “vasculitis [kidney.org]

    The major complication was perineal sepsis. [east.org]

    Devitalized parenchyma, hematoma, and urinoma are common causes of infection, abscesses and sepsis. Urine extravasation results from disruption of UPJ or from tears extending to the collecting system. [sjosm.org]

    Failure to repair intraperitoneal bladder injuries can result in translocation of bacteria from the bladder to the abdominal cavity resulting in peritonitis, sepsis, and other serious complications. [auanet.org]

Gastrointestinal

  • 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]

  • Intestinal Perforation

    Unfortunately, there are still many other potential abdominal injuries that like to hide and take even more time to develop, including duodenal hematoma or intestinal perforation or mesenteric tears. [mddirect.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]

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]

  • Insect Bite

    ) effects of foreign body in stomach, small intestine and colon ( T18.2- T18.4 ) frostbite ( T33-T34 ) insect bite or sting, venomous ( T63.4 ) Injuries to the abdomen, lower back, lumbar spine, pelvis and external genitals S37 ICD-10-CM Diagnosis [icd10data.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]

  • 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]

  • 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]

  • Urinary Retention

    Physical examination Common symptoms include urethral bleeding, bruising along the flank, urinary retention, lower abdominal distention and pain, and swelling and edema of the genitalia. [medical-dictionary.thefreedictionary.com]

    She experienced an episode of bladder hypotonia and urinary retention, which mandated admission and conservative management. Five weeks later, the mother is free of any urinary symptoms and continues under the care of the Department of Urology. [omicsonline.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]

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