Kidney injuries account for approx. 10 percent all abdominal injuries. A kidney injury is when the kidney is deflected or ruptured. This includes kidney contusion. These types of injuries usually occur after an impact, a fall or a traffic accident. Their consequence may be a hematoma on the kidney. Then surgery may be necessary. What are the types of kidney injuries? How to recognize their symptoms? What is the therapy?

Kidney injuriesconstitute approx. 10 percent all abdominal injuries. A kidney injury iskidneyisreflectedorruptured.This also includescontusion of the kidney . These types of injuries can occur after an impact, fall, or traffic accident. Their consequence may behematoma on the kidney . Then surgery may be necessary.

Kidney injuries (deflected, cracked, bruised kidney) - classification, causes

There are two groups of kidney injuries: blunt (closed) and penetrating (open). Traffic accidents account for the leading cause of nearly half of blunt kidney injuries. They can also be the result of a beating, falling, or accident related to practicing contact sports.

The group particularly vulnerable to kidney injuries are young men practicing sports, participants in road accidents, victims of accidents at home or at work.

Penetrating injuries, on the other hand, are most often the result of gunshot and stab wounds.

In the case of kidney injuries, especially transport injuries, there is a high probability of damage to other organs (spleen, large intestine, liver, pancreas, large blood vessels). If it is an open, piercing kidney injury, the probability reaches 80%, in blunt and closed injuries it drops to 20%. Closed injuries account for over 90 percent. all kidney injuries.

Kidney disease, cysts and cystic disease, hydronephrosis, nephrolithiasis, chronic inflammation, developmental anomalies and cancer are factors that make the kidney more susceptible to injury.

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Kidney injuries (reflected, cracked, bruised kidney) - symptoms

  • hematuria

No.haematuria must always be associated with the kidney injury itself, it may be the result of damage to another organ. At the same time, the lack of hematuria does not exclude a kidney injury.

  • pain in the back, lateral region, chest or abdomen
  • tight abdomen, muscle defense, and a palpable mass in the abdomen
  • renal colic
  • bruising in the lumbar region or upper abdominal quadrants and soreness in this area

Kidney injuries (deflected, cracked, bruised kidney) - diagnosis

Initial diagnosis in case of suspected kidney injury consisted of abdominal ultrasound, urinalysis, laboratory tests: blood count, electrolytes, clotting time, creatinine and urea. It is also necessary to determine the hematocrit index. Other imaging tests used in the diagnosis of injuries of the genitourinary system and kidneys include: ultrasound, computed tomography, urography, angiography and arteriography.

Kidney injuries (deflected, cracked, bruised kidney) - treatment

The American Association for Surgery of Trauma has developed a classification of kidney injuries that is also valid in Europe. This classification includes five degrees:

1. Contusion of the kidney, subcapsular hematoma. 2. Rupture of the renal parenchyma, not exceeding the cortex-core border of the kidney. 3. Damage to the core of the kidney, but no damage to the cup-pelvic system 4. Rupture of the kidney with damage to the cup-pelvic system and / or damage to the segmental vessel. 5. Fragmentation of the kidney parenchyma and / or damage to the renal pedicle.

The indication for surgery in the event of a kidney injury will be a fifth degree injury and the increase in symptoms despite proper treatment (enlargement of the urinary leak and hematoma, poor blood test results, deteriorating general condition).

First and second degree injuries are usually treated conservatively - it is absolutely recommended to lie in bed (for a few days after symptoms and hematuria have subsided) and refrain from exercise for about 6 weeks. Your doctor may decide to give you antibiotics prophylactically. During this time, regular monitoring of vital signs, abdominal symptoms, hemoglobin levels and hematocrit values ​​are necessary.

In the case of third and fourth degree injuries, the procedure is determined by the type of injury (open or closed), the patient's general condition, his / her capacity and kidney function. Fourth degree injuries, classified as severe, with proper management (CT, antibiotics, maintaining the patency of the ureter)- internal splinting catheter) in 75 percent. cases have a chance of being cured without surgery.

Only the fifth degree of damage is an absolute indication for immediate surgery.

Every patient after a kidney injury, regardless of its degree and clinical symptoms, should be monitored in the hospital.

Kidney injuries (deflected, cracked, bruised kidney) - complications

Early complications - occurring in the first month after the injury - can be:

  • bleeding
  • infection
  • perirenal abscess
  • sepsis
  • urinary fistula
  • hypertension
  • cyst containing urine

Delayed retroperitoneal bleeding occurs weeks after the onset of injury and can be life-threatening.

Bibliography:

1. Bużański T., Injuries of the urinary system, "Postępy Nauk Medycznych" 2014, nr 1

2. Ząbkowski T., Skiba R., Grabińska A., Maliborski A., Syryło T., Zieliński H., Kidney injuries - symptoms and diagnostics, "Pediatrics and Family Medicine" 2013, no. 9

3. Ząbkowski T., Skiba R., Grabińska A., Maliborski A., Syryło T., Zieliński H., Kidney injuries - treatment, "Pediatrics and Family Medicine" 2013, no. 9

Category:

Urology and Nephrology