Renal Trauma

Renal Trauma


RENAL INJURY

  • Renal trauma is due to-

a) Minor injuries- blunt trauma (RTA, falls, assaults & sporting injuries)

b) Major injuries – penetrating trauma (knife or gunshot wounds)

  • Blunt trauma is much more common than penetrating trauma.
  • Renal injuries are classified as follows-

1. Grade I-

  • Contusion or non-enlarging subcapsular perirenal haematoma, and no laceration.

2. Grade II-

  • Superficial laceration

3. Grade III-

  • Laceration >1 cm without extension into the renal pelvis or collecting system (no evidence of urine extravasation).

4. Grade IV-

  • Laceration extends to renal pelvis or urinary exrravasatlon.
  • Vascular: injury to main renal artery or vein with contained haemorrhage.
  • Segmental infarctions without associated lacerations.
  • Expanding subcapsular haematomas compressing the kidney.

5. Grade V-

  • Shattered kidney.
  • Avulsion of renal hilum: devascularisation of a kidney due to hilar injury.
  • Ureteropelvicavulsions.
  • Complete laceration or thrombus of the main renal artery or vein.

 

 

Clinical features-

  • Hematuria is the most important sign of renal injury.
  • Loin bulge due to perinephric haemtoma.
  • Bruising of soft tissue in the loin.
  • Retroperitoneal haematoma –> abdominal distension.
  • systolic blood pressure ≤90 mmHg

Investigations-

  1. Intravenous pyelography (IVP) can shows (An IVP is done urgently to assesss the damage to the kidney and to know the functioning of the other kidney)-
  • Intrarenal extravasation
  • Extrarenal extravasation
  • Function of injured kidney

2. CT scan with contrast is the IOC

3. USG

Treatment-

  • Blunt trauma are treated conservatively
  • Penetrating injuries, small & major lacerations- surgical exploration.

Exam Important

  • Renal injuries are classified as follows-

1. Grade I: contusion or non-enlarging subcapsular perirenal haematoma, and no laceration.

2. Grade II: superficial laceration

3. Grade III: laceration >1 cm without extension into the renal pelvis or collecting system (no evidence of urine extravasation).

4. Grade IV

  • Laceration extends to renal pelvis or urinary exrravasatlon.
  • Vascular: injury to main renal artery or vein with contained haemorrhage.
  • Segmental infarctions without associated lacerations.
  • Expanding subcapsular haematomas compressing the kidney.

5. Grade V:

  • Shattered kidney.
  • Avulsion of renal hilum: devascularisation of a kidnev due to hilar injury.
  • Ureteropelvicavulsions.
  • Complete laceration or thrombus of the main renal artery or vein.

 

 

Clinical features-

  • Hematuria is the most important sign of renal injury.
  • Loin bulge due to perinephric haemtoma.
  • Bruising of soft tissue in the loin.
  • Retroperitoneal haematoma –> abdominal distension.
  • systolic blood pressure ≤90 mmHg

 

Investigations-

  1. Intravenous pyelography (IVP) can shows-
  • Intrarenal extravasation
  • Extrarenal extravasation
  • Function of injured kidney

2. CT scan with contrast is the IOC

3. USG

 

 

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