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Traumatic Rupture of the Kidney

Traumatic Rupture of Kidney


Presentation

  • We present a fifteen-year-old male with previously unsuspected horseshoe kidney that suffered an atypical right upper-pole and mesorrenal kidney rupture after low-velocity-impact blunt abdominal trauma.[ncbi.nlm.nih.gov]
  • 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]
  • No treatment is needed, and the patient can be discharged if no other injuries are present. The blood will clear over a few days, but may disappear and reappear a few times in the process.[regionstraumapro.com]
Pain
  • 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]
  • Management Frontiers in Medicine Epidemics Zika Virus Ebola Virus View all topics Health Policy Epidemics Pain Management Ebola Virus Multimedia Multimedia Selected Multimedia View all multimedia Audio Clinical Practice Audio Interviews Interactive Medical[nejm.org]
  • The pain will be constant in the beginning, and changing position does not alter the pain. The pain is related to stretching of the kidney.[livestrong.com]
  • Your child may have some pain or soreness at home. Give Acetaminophen (also known as “Tylenol") for pain. Your child's trauma surgery provider may also write a prescription for stronger pain medication.[cincinnatichildrens.org]
  • Patients with bladder injuries may have symptoms such as hematuria (blood in urine), painful or difficulty in urination, and lower abdominal pain.[newcastleurology.com.au]
Physician
  • […] logo-32 logo-40 logo-60 New England Journal of Medicine NEJM Group Follow Us Facebook Twitter Instagram YouTube LinkedIn Blog Prepare to become a physician, build your knowledge, lead a health care organization, and advance your career with NEJM Group[nejm.org]
  • Página 125 - The British Thoracic Society, the National Asthma Campaign, the Royal College of Physicians of London in association with the General Practitioner in Asthma Group, the British Association of Accident and Emergency Medicine, the British Paediatric[books.google.es]
  • There is no cure for chronic renal problems therefore the physician will work to manage the disease.[traumasurvivorsnetwork.org]
  • Athletes are not typically allowed to return to play to contact sports with one organ that is normally paired, however some physicians or circumstances may allow it.[ksi.uconn.edu]
  • The patient can followup with their primary care physician in a week or two.[regionstraumapro.com]
Fever
  • Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Case 3-2019: A 70-Year-Old Woman with Fever, Headache, and Progressive Encephalopathy Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura Randomized[nejm.org]
  • If you have a fever in addition to these symptoms, seek medical care right away because you could have a serious kidney infection.[livestrong.com]
  • The common symptoms of ureteral injury include abdominal or flank pain, urine leakage, fever, infection, and blood in the urine.[newcastleurology.com.au]
  • […] 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]
  • […] disease Radiation to the belly area Trauma Emergency symptoms may include: 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[medlineplus.gov]
Asymptomatic
  • Abstract One-third to one-half of all patients with horseshoe kidney are asymptomatic and the condition is found incidentally.[ncbi.nlm.nih.gov]
  • Ureteropelvic junction (UPJ) obstruction, a major cause of obstructive uropathy and the most frequently encountered asymptomatic congenital anomaly of the urinary tract [5], is one of the pre-existing abnormalities most found after renal trauma [6].[urotoday.com]
Anemia
  • Low blood pressure and anemia may occur in case of severe injury if more volume of blood is lost because of injury. Treatment depends on the type and severity of injury.[newcastleurology.com.au]
  • Explain the possibility of complications to recovery, such as poor wound healing, infection, and anemia. As needed, provide information about any follow-up laboratory procedures that might be required after discharge from the hospital.[medical-dictionary.thefreedictionary.com]
Abdominal Pain
  • Critical Essential Core Tested Community Questions (2) (SBQ07SM.24) A high school hockey player develops diffuse abdominal pain accompanied by nausea and vomiting after a typical body check into the boards. A CT scan shows a ruptured spleen.[orthobullets.com]
  • Children with a kidney injury may have bruising, pain in their back, blood in their urine, or abdominal pain after the trauma or injury. If a kidney injury is suspected, the trauma surgery providers will thoroughly and carefully examine your child.[cincinnatichildrens.org]
  • 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]
  • On physical examination, there are abdominal pain, two incised wounds in right abdomen and haematuria.[austinpublishinggroup.com]
  • If you notice severe side, low-back or abdominal pain, with or without blood in your urine, contact your doctor.[livestrong.com]
Abdominal Distension
  • distension following trauma to the mesogastrium.[karger.com]
  • Abdominal, flank, and back inspection and examination is very important, for detection abrasions, ecchymosis, fractured ribs, abdominal distension, renal mass, and tenderness. [23] Complications Early complications can occur within 1 month after the injury[sjosm.org]
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]
  • 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 Renal[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]
  • Hypertension Chronic heart failure Diabetes Multiple myeloma Chronic infection Myeloproliferative disorder Connective tissue disorders Autoimmune diseases Look for these symptoms in athletes when a kidney rupture is suspected: Hematuria (blood in urine[ksi.uconn.edu]
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]
  • 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 Renal[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]
  • Hypertension Chronic heart failure Diabetes Multiple myeloma Chronic infection Myeloproliferative disorder Connective tissue disorders Autoimmune diseases Look for these symptoms in athletes when a kidney rupture is suspected: Hematuria (blood in urine[ksi.uconn.edu]
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]
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]
  • 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]
  • Fig. 2 Transverse views of the computed tomography scan of the abdomen, illustrating right renal cysts with surrounding soft tissue stranding and retroperitoneal fluid While experimental models have suggested that the presence of renal cysts and hydronephrosis[criticalultrasoundjournal.springeropen.com]
Headache
  • Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Case 3-2019: A 70-Year-Old Woman with Fever, Headache, and Progressive Encephalopathy Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura Randomized[nejm.org]
  • ., heart, liver) Overuse of pain medicines called “ NSAIDs ”, which are used to reduce swelling or relieve pain from headaches, colds, flu, and other ailments. Examples include ibuprofen, ketoprofen, and naproxen.[kidney.org]
  • Leading to symptoms such as tiredness, headache, loss of appetite, vomiting, and nausea. If the potassium level rises too much beyond normal, cardiac arrhythmias can occur, which can be life threatening or, at the very least, dangerous.[autoaccident.com]
Encephalopathy
  • Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Case 3-2019: A 70-Year-Old Woman with Fever, Headache, and Progressive Encephalopathy Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura Randomized[nejm.org]
Hematuria
  • 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]
  • The lack of hematuria does not exclude severe renal trauma.[urology-textbook.com]
  • Hematuria was the most frequent manifestation (21 patients [84%]), followed by flank pain (17 patients [68%]).[ncbi.nlm.nih.gov]
  • 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]
Hematuria
  • 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]
  • The lack of hematuria does not exclude severe renal trauma.[urology-textbook.com]
  • Hematuria was the most frequent manifestation (21 patients [84%]), followed by flank pain (17 patients [68%]).[ncbi.nlm.nih.gov]
  • 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]
Renal Injury
  • This congenital renal anomaly has shown as a predisponent condition for renal injury in blunt abdominal trauma, but often the degree of injury has a nonoperative therapy.[ncbi.nlm.nih.gov]
  • Types The vast majority (95-98%) of renal injuries are minor.[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 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]
  • Renal injury with different grades happened in 10.6% of them and 3% of them had sport-related renal injury, with male-to-female ratio of 9:1. [14] The literature showed the incidence of renal injury in children accounts for 10% of all significant blunt[sjosm.org]
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]
  • Fever, dropping blood count or flank pain are indications for repeated imaging (ultrasonography or CT).[urology-textbook.com]
  • There should be abdominal pain or flank pain and tenderness when the flank is palpated (felt by the health-care provider during a physical exam).[medicinenet.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]

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

  • Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Case 3-2019: A 70-Year-Old Woman with Fever, Headache, and Progressive Encephalopathy Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura Randomized[nejm.org]
  • 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]

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]
  • […] 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]

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]

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]
Sex distribution
Age distribution

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]
  • 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]
  • For severe injuries, measures are taken to avoid blood loss and prevent shock. In addition intravenous infusions or blood transfusion may be required to maintain the normal blood pressure as well to stimulate the urine production.[newcastleurology.com.au]

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