What Is Kidney Trauma?

Classification and cause of injury: It can be divided into open injury and closed injury. The former is more common in firearm penetrating injuries during wartime.

Kidney trauma

The kidneys are located in the posterior peritoneal space on both sides of the lumbar spine, surrounded by thick fat pads and have a certain degree of mobility. It is also protected by the spine, bones, internal organs, and muscles. It is generally not easy to be injured. Renal trauma is more common in young men, which is related to factors such as more professional and physical activities. With the development of modern industry and transportation, the incidence has ranked first in urogenital trauma.

Causes of kidney trauma

Classification and cause of injury: It can be divided into open injury and closed injury. The former is more common in firearm penetrating injuries during wartime.

Kidney trauma Or blade injuries, usually puncture injuries, and more often associated with chest and abdominal organ injuries; the latter are more common, the causes of injuries are divided into direct violence and indirect violence. Direct violence: Impact or compression on the lower back or upper abdomen can cause kidney damage. Violence from the back or front can cause the ribs to move forward or the kidneys to move backwards, acting on the kidney and causing injury. It is more common in traffic accidents, when the soil slope collapses or falls from a height and focuses on hard objects. This is the most common reason.

Indirect violence: Deceleration injuries caused by falling from the ground, landing on the feet or buttocks, and sharp braking. This indirect violence can cause tearing of the renal pedicle or rupture of the pelvic ureter junction.

Strong contraction of lumbar muscles can also cause kidney contusion and hematuria.

Renal rupture can also be caused by a slight external force on a kidney (congenital or acquired organic disorder) that has already been pathologically changed, and is often referred to as spontaneous renal rupture.

The type of injury can be divided into:

Contusion: The capsule is intact and does not involve the collective system. It is limited to damage to the renal parenchyma or subcapsular hematoma. Light hematuria, no abnormal findings on plain X-ray abdomen film and urography, B-ultrasound or CT examination can find the renal parenchyma hematoma and its size and location.

Laceration: one or more deep fissures in the kidney parenchyma. If the gap is connected with the renal pelvis, hematuria is severe. If the capsule is ruptured, blood and urine extravasation form a hematoma around the kidney. If the peritoneum ruptures at the same time, blood and urine can flow into the abdominal cavity. X-ray abdomen plain film showed renal shadow increased, uneven density. Contrast spills are common in urography. B-ultrasound showed that renal parenchyma was divided by hematoma. Those with severe injuries often cause shock.

Crush injury: The renal parenchyma was broken into several pieces together with the capsule, and the collective system was also ruptured at the same time, with severe bleeding and extravasation of urine. Urinary angiography does not show kidney development or delayed development, and a large amount of contrast agent overflows. Renal arteriography showed that renal vascular branches were not visualized. He is seriously injured and often leads to death if he is not actively rescued.

Rupture of the renal pelvis: Often accompanied by a parenchyma of the renal parenchyma, simple rupture of the renal pelvis is rare, showing signs of urine extravasation

Renal pedicle injury: If the renal pedicle is completely ruptured, a large amount of bleeding is often too late to be rescued. Small vessel ruptures can sometimes self-embolize, and renal parenchyma is not visualized with angiography.

Kidney trauma symptoms

It depends on the strength of the external force and the degree of renal parenchymal damage.

Kidney trauma 1. Shock: Shock can occur due to trauma and / or bleeding. Complicated injuries are more likely to occur when the abdominal organs are damaged. Therefore, it is important to closely observe vital signs during treatment.

2. Hematuria: It is the most common and important symptom of renal trauma, and is more common with gross hematuria. It is worth noting that the degree of hematuria does not necessarily match the severity of the trauma. Therefore, the severity of the injury cannot be judged clinically by the amount of blood in the urine. When the hematuria is not heavy, it usually disappears within a few days. If the activity is too early after the injury or the infection is complicated, secondary blood may appear.

3 Local mass: extravasation of blood and urine to the tissues surrounding the kidney, which can lump and lumps deep in the upper abdomen, and should be observed for continued enlargement. If the local pain is exacerbated with high fever, the white blood cells increase, which is a manifestation of infection around the kidneys.

4 Pain and muscle tension: Injury to the soft tissue, renal parenchymal injury, and renal capsule irritation can cause pain in the waist or upper abdomen. Colic can also cause colic if the clot blocks the ureter. Extravasated blood and urine can cause typical peritoneal irritation symptoms when flowing into the abdominal cavity. Pain may be muscle tension and tenderness.

5. Symptoms of Complicated Injury: Open or closed kidney injury may be accompanied by damage to the chest, abdominal organs, spine or distant tissue. Clinically, they often conceal their symptoms and signs from each other, and they should be paid attention during diagnosis, otherwise they may easily lead to missed diagnosis and misdiagnosis.

6. Open kidney injury: According to the site and direction of the wounded tract and leakage of the wounded tract, it is estimated that there is renal trauma, but the wound may not have a large amount of bleeding or urine leakage. Since such trauma has combined injuries, early surgical exploration should be performed.

Criteria for diagnosis of severe kidney injury

At present, kidney injury is divided into three types: mild injury (contusion) and minor laceration, moderate injury (laceration), and severe injury (fracture and renal pedicle injury).

Divided into 5 grades according to the standards of the American Trauma Surgery Association: Grade kidney injury or subcapsular hematoma without renal parenchyma

Kidney trauma Grade II perirenal hematoma is confined to the retroperitoneal space or cortical fissure 1.0 cm without urinary extravasation; Grade IV parenchyma exceeds the junction of the cortex and pulp and enters the collecting system, and renal segment arteries and veins are damaged; Grade kidney comminuted injury, kidney Pedicle tear, renal artery thrombosis. These classification and grading methods only take into account the damage of the kidney itself and do not include other organ damage. For the treatment of specific patients with kidney damage, the degree of kidney damage should be considered, and systemic injuries must also be considered.

Hematuria is an important symptom of kidney injury, but the degree of hematuria is not the same as the degree of injury. Hematuria of renal pedicle vascular injury is relatively rare, and urinary bladder rupture is not serious. Special attention should also be paid to those who have no renal hematuria clinically. Surgical indications depend on the degree of renal injury. Most of them have gross hematuria and microscopic hematuria, which are confirmed by B-ultrasound, CT, and bladder injection tests.

Imaging examination is very important to determine the extent and scope of renal injury. For many years, IVU has been used as one of the important methods for diagnosing renal injury. The diagnostic accuracy rate is about 80%, but the disadvantage is high false positive rate, especially those with mild injury. In severe cases, the injured kidney does not develop, and a large dose of IVU must be used. B-ultrasound has a better resolution of the tissues, and it is ideal for observing the morphology of damaged kidneys and understanding the retroperitoneal lesions. CT is accurate in judging the degree of kidney injury, and can determine the extent of urinary extravasation and hematoma. First, it is the inactive kidney tissue, and it can understand the condition of the contralateral kidney, liver, spleen, and large blood vessels, so it is an important method for diagnosing kidney injury. The accuracy of qualitative diagnosis and classification of kidney injury is 100%, which is significantly better than IVU and B-ultrasound.

Renal Trauma Examination

(1) Urine: Hematuria is an important basis, so a urine test is extremely important. If you cannot urinate by yourself,

Kidney trauma Catheterization should be performed.

(2) X-ray inspection:

Plain abdominal film: kidney contusion is generally not found abnormally. Renal lacerations show enlarged or blurred kidney shadows, psoas muscle shadows disappeared, the spine protruding to the healthy side, or fractures. If it is a bullet wound, a metal foreign body can be seen.

Excretory urography: should be performed with the allowance of injury. It is generally necessary to use double or high-dose contrast agents to obtain the desired results. This method can not only understand the situation of kidney injury but also check the existence and function of the contralateral kidney. When the kidney is contused, the renal pelvis and kidney calves show normal, and the kidney calves can be slightly displaced due to subcapsular hematoma. Renal laceration can be seen in the delayed development of part of the calves, the place where the contrast agent overflows is the parenchyma of the renal parenchyma. Pulmonary pelvis and kidney calves were not visualized or there were multiple contrast agent spills during comminuted injury.

Renal artery angiography: It is not used as a routine test. It is only performed when the failure of pyelography cannot be diagnosed.

Retrograde pyelography: This method has diagnostic value for collective system trauma as a supplementary examination. Because of its susceptibility to infection and some pain, it has rarely been used clinically.

(3) Nuclide kidney scan: the scan shows normal when contused. The laceration shows that the shape of the kidney is not smooth. The hematoma showed a radioactive cold area. Can be used as a supplementary check.

(4) B-mode ultrasound and CT examination: both the renal parenchyma and the location and extent of hematoma can be detected.

Renal Trauma Treatment

(I) Principles for treatment of closed injuries:

1. Renal contusion and superficial laceration: Non-surgical treatment is generally used.

(1) Absolute bed rest for at least 14 days.

Kidney trauma (2) Transfusion or blood transfusion if necessary.

(3) Analgesics and hemostatic drugs.

(4) Antibiotics to prevent infection.

(5) Closely observe changes in the condition, changes in vital signs, hemoglobin, hematocrit, blood volume in urine, and abdominal mass size.

2. Severe renal lacerations or comminuted injuries and rupture of the collection system with a large amount of extravasation of urine should be treated surgically.

(2) Treatment of open injuries: After the general condition of the wounded is improved, surgical treatment is used to detect kidney and other organ traumas and give appropriate treatment. Drainage of the wound after surgery.

(C) Surgery method: To detect closed kidney trauma, an abdominal incision should be taken to detect the combined injuries of abdominal organs and the condition of the contralateral kidney. Before exploring the injured kidney, the renal blood flow should be blocked to reduce the amount of bleeding, and the rate of nephrectomy can also be reduced.

(IV) Renal artery embolization: In recent years, selective renal artery embolization has gradually been applied to traumatic renal hemorrhage, especially for cases where orphaned kidney injury is not suitable for surgery, and it has the effect of preserving residual renal function.

Kidney trauma identification

Need to identify which type:

Rupture of the renal pelvis: Often accompanied by a parenchyma of the renal parenchyma, simple rupture of the renal pelvis is rare, showing signs of urine extravasation.

Renal pedicle injury: If the renal pedicle is completely ruptured, a large amount of bleeding is often too late to be rescued. Small vessel ruptures can sometimes self-embolize and renal parenchyma is not visualized with angiography

Renal trauma complications

After renal trauma, early complications include secondary bleeding, kidney and perirenal infections, and urinary fistula formation. Late complications include hydronephrosis, pyelonephritis, hypertension, kidney stones, urinary cysts, renal arteriovenous fistula, and nonfunction. Kidneys, etc.

Open or closed kidney damage may be accompanied by damage to the chest, abdominal organs, and spine or distant tissue. Clinically, they often conceal their symptoms and signs from each other, and they should be paid attention during diagnosis, otherwise they may easily lead to missed diagnosis and misdiagnosis.