Males accounted for the majority of renal trauma cases, similar to the 3. Kidney renal trauma is when a kidney is injured by an outside force. Renal artery pseudoaneurysm after blunt renal trauma. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where nonoperative management is considered the. This difference has been attributed to the involvement of men in highrisk activities. In patients with renal trauma that does not involve the renal vessels, the conservative management success rate is up to 95%27. The 230 patients without renal injury had an incidence of renal failure of 7. Nonoperative and minimally invasive management techniques for both blunt and penetrating renal trauma have become standard of care over the past decades.
Injury grade roughly defined correlated with renal salvage rate. Journal of emergency and trauma care imedpub journals. Urotrauma guideline american urological association. Advances in radiographic staging, improvements in hemodynamic monitoring, and wider use of angioembolization have improved the rates of renal preservation and decreased unnecessary surgery the majority of blunt and many penetrating injuries to the kidneys no longer require open. The urinary tract is commonly involved in abdominal trauma, accounting for 810% of trauma related injuries to abdominal organs. The prevalence of renal trauma among trauma patients ranges from 0. Of the injuries, 74% were classified as contusions and needed only conservative. Delayed images should be done about 10 to 15 minutes after the initial study. Other studies only a few were done did not correlate as well. Penetrating injuries usually result from gunshot wounds and are usually associated. Renal injuries have a wide range of mortality 0% to 19.
The best sign of blunt kidney injury is blood in the urine hematuria. The american association for the surgery of trauma aast renal injury scale, most recently updated in 2018, is the most widely used grading system for renal trauma. Any patient who has sustained blunt abdominal trauma and has either macrohematuria or microhematuria renal trauma and hypertension. Renal trauma and hypertension the role ofrenin richard f. In blunt abdominal trauma, up to 40% present with renal injury. Blunt renal injuries are the cause of greater than 90% of renal injuries in children, and the kidney is the most common organ injured in blunt abdominal trauma. Jan 30, 2019 males accounted for the majority of renal trauma cases, similar to the 3. Patients presenting to aintree university hospital with renal trauma between june 2012 and june 2016 were identified using the trauma audit and research network tarn database.
Injury scoring scale a resource for trauma care professionals. Renal trauma management has evolved during the last decades, with a clear transition toward a nonoperative approach. Arc was defined as a measured crcl of mlmin or greater. Considering that the kidneys receive 20% of cardiac output via the renal artery, any compromise to the vessels is serious. Genitourinary trauma, management of practice management. Renal injuries account for 10% of abdominal trauma, and thus the demographic of affected individuals reflects that population. Civilian renal injury occurs in up to 5% of trauma victims, 10, 11 and accounts for 24% of traumatic abdominal solid organ injuries. Death and renal failure occurred in of the 230 patients without renal injury 5. We sought to examine the modern epidemiology of renal trauma over the past decade. Patients who suffer from blunt abdominal trauma account for most renal injuries, either due to direct impact or rapid deceleration 1,2,3,4,5. Com monly, the specific pathologic fea tures observed after renal trauma is subcapsular perinephric hematoma, which in theoreticalconstruct is anal ogous to the cellophane perinephritis originallydescribedbypage. However, the absence of hematuria does not preclude significant renal injury.
More than 95% of kidney injuries are considered minor and nonoperative therapy has been successfully utilized without serious complications. Hill, lauren bakios, jayashree krishnan, krishnan venkatesan, mohan verghese. Methods consecutive trauma patients who were admitted to the intensive care unit between march 2015 and january 2016 and had a measured creatinine clearance crcl were considered for inclusion. Renal trauma has been implicated as a causative factor in some forms of renal hypertension. Successful nonoperative management of highgrade blunt. Contemporary management of acute kidney trauma sciencedirect.
Aast kidney injury scale radiology reference article. The incidence of renal injuries increases in preexisting congenital or acquired renal pathology e. When a highgrade renal injury is suspected, contrastenhanced ct should be done to determine the grade of renal injury and identify accompanying intraabdominal trauma and complications, including retroperitoneal hemorrhage and urinary extravasation. Renal and urogenital injuries occur in approximately 1020% of abdominal trauma in adults and children. Management of renal injury in a uk major trauma centre. Kidney renal trauma is when the kidney is hurt by an outside force. We present an overview of renal trauma as illustrated by three interesting cases of blunt renal trauma who presented in quick succession of each other to the. Most renal injuries 85 to 90% of cases result from blunt trauma, typically due to motor vehicle crashes, falls, or assaults.
Nov 11, 2012 these patients can demonstrate true urological emergency. Identifying augmented renal clearance in trauma patients. There are two types of trauma blunt and penetrating trauma. Grade iii injuries the difference between grade ii and grade iii is the depth of renal laceration, with grade iii corresponding to a laceration greater than 1 cm, without the collecting systems involvement. Incidence and management of penetrating renal trauma in patients with multiorgan injury. A synthesis of prevailing thought is depicted diagrammatically in figure 2 and is summarized as follows. Current management of highgrade blunt renal trauma favors a nonoperative approach when possible. The american association for the surgery of trauma aast has produced an organ severity scale for the grading of renal trauma, in accordance with extent of injury sustained. Blunt trauma damage caused by impact from an object that doesnt break the skin. The data gathered retrospectively for each patient included mechanism of injury, injury severity score, american association for the surgery of trauma aast grading. Renal vein plasma renin activityprafrom the traumatized kidney was three to eight timesgreaterthanrenalvein prafromthe. Trauma is a leading cause of death and disability worldwide.
The most common accompanying injuries are to the head, central nervous system, chest, spleen, and liver. Trauma produced perinephric hematoma in two and renal arterythrombosis in one. Injury scoring scale the american association for the. Nowadays, ct plays a major role in investigation of renal trauma and is currently the imaging modality of choice. Acute kidney injury aki, formerly termed acute renal failure, is characterized by a sudden deterioration in renal function. In 435 76% of the 569 survivors longterm followup data and blood pressure recordings were obtained, months to 12 years after trauma mean, 5. Nonneoplastic pathologic findings in nephrectomy specimens. Patients with preexisting pathologic kidneys may sustain injury from minimal trauma, and the extent of hemorrhage may be disproportionate to what was expected on the basis of the.
In general, hematuria 5 red blood cells per highpower field is present in over 95% of patients who sustain renal trauma, 1. Contemporary evaluation and management of renal trauma a male predominance of 3. In general, blunt injuries are more common, accounting for up to 90%95% of renal injuries. Successful nonoperative management of highgrade blunt renal. Renal injury occurs in approximately 8%10% of blunt or penetrating abdominal trauma, and 1%5% of all traumas. The journal of renal care jorc, formally the edtnaerca journal, is the official publication of the european dialysis and transplant nursing association european renal care association edtnaerca. In ski resorts, 23 of renal injuries are due to skiing accidents. Renal trauma is more commonly seen in young males, with a mean age of 30. Over the last 20 years, both technology and technical skill pertaining to selective embolization have shown promise in the trauma setting 36. We performed a retrospective study of high grade blunt renal injuries at our level i trauma center to determine the indications and success of nonoperative management nom.
How does the mechanism of injury to the kidney alter the evaluation of the patient with renal trauma. Spark,md,solomon berg,md three patients developed hyperten sion following renal trauma. Of those 71 patients, 18 proved to have type iii renal injuries which was classified as major laceration with or without urinary extravasation. Renal trauma free download as powerpoint presentation. The epidemiology of renal trauma voelzke translational.
Renal trauma patients are largely managed conservatively but on occasion have to be embolised or taken to theatre for definitive surgical management, usually in the form of emergency nephrectomy. Ct is important in order to characterize and grade. But injuries can happen as a result of blunt trauma or penetrating trauma. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. Despite its relatively protected retroperitoneal position, the kidney is the most commonly injured organ of the genitourinary system during trauma. Current concepts of management of renal trauma tend to promote the use of less invasive procedures and conservative management. The aasts list of organ injury scaling tables originated in a set of papers that published in the journal of trauma. A practical guide to evaluation and management article pdf available in the scientific world journal 4 suppl 1. The largest percentage of such injuries occurred in the age group 1014 and were seen after falls or automobile accidents. First, the accumulative knowledge about the safety and outcome of the renal trauma nonoperative approach, 1 17 and also for the management of other. Renal trauma in a trauma intensive care unit population. Renal trauma can result from direct, blunt, penetrating and iatrogenic injury. Review of the evidence on the management of blunt renal trauma in pediatric patients. For the majority of renal injuries, nonoperative management is the standard of care with nephrectomy reserved for those with severe trauma.
Ver y little dedicated research has been performed to evaluate the role for rae in the setting of penetrating renal trauma. Retrograde filling of the renal vein on computerized tomography for blunt renal trauma. This scale has been prospectively validated and is directly associated with the need for surgical management in renal trauma patients. A retrospective study 19721983 was made of 622 consecutive patients who suffered renal trauma, in order to assess the incidence and prevalence of posttraumatic renal hypertension. The kidney is the organ most commonly associated with urological trauma and is involved in 120% of trauma cases.
This study in a dedicated trauma intensive care unit ticu population aimed to assess the outcomes of renal injuries and identify factors that predict the need for nephrectomy. April 2016 contemporary evaluation and management of renal trauma a male predominance of 3. Your kidneys are guarded by your back muscles and rib cage. Sometimes the blood can be seen with the naked eye. Authors submitting a paper do so on the understanding that the manuscript has been read and approved by all authors and that all authors agree to the submission of the manuscript to the journal. The effects of treatment of renal trauma on renal function. Patients with chronic hydronephrosis, renal infection, simple renal cysts, and renal cell cancers are also at increased risk of sustaining renal trauma 1, 2. Altogether 57 papers were found using the reported search, of which 10 presented the best evidence to answer the clinical question. In this paper we discuss renal trauma and its management, illustrated by three cases of blunt renal trauma managed differently. Contemporary evaluation and management of renal trauma. Acute kidney injuryan overview of diagnostic methods and. In urban areas, 80% of renal injuries occur in the context of polytrauma. The journal of renal care adheres to the below ethical guidelines for publication and research. The improvements in imaging and the use of a validated renal injury grading system has helped to.
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