Renal

Kidney Trauma

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Kidney Trauma, Renal Injury, Renal Contusion, Kidney Laceration, Hemorrhage of Kidney, Renal Hemorrhage

  • See Also
  1. Abdominal Injury
  • Causes
  1. Blunt Trauma to the flank or left upper quadrant Abdomen
  2. High velocity impact injury
  3. Penetrating Abdominal Trauma
  • Risk Factors
  1. Children are higher risk from Kidney injury in Blunt Abdominal Trauma
  • Symptoms
  1. Gross Hematuria
  2. Flank Pain
  • Signs
  1. Hypotension
  2. Ecchymosis at flank
  3. Costovertebral Angle Tenderness (CVA Tenderness or flank tenderness)
  • Labs
  1. Comprehensive metabolic panel
  2. Complete Blood Count
  3. Urinalysis with microscopic exam
  • Imaging
  1. CT Abdomen and Pelvis with IV Contrast
    1. Preferred first line study
  2. Intravenous pyelogram
    1. Rarely used in U.S., but consider if CT not available
    2. May demonstrate non-functioning Kidney or significant extravasation
      1. Consider angiography in Grade 3 Injury or greater
  • Grading
  1. Grade 1 Renal Injury
    1. Contusion or subcapsular Hematoma and
    2. No parenchymal Laceration
  2. Grade 2 Renal Injury
    1. Non-expanding perirenal Hematoma or
    2. Renal or cortical Laceration <1 cm without urinary extravasation
  3. Grade 3 Renal Injury
    1. Parenchymal Laceration depth >1 cm into renal cortex AND
    2. No rupture or urinary extravasation
  4. Grade 4 Renal Injury
    1. Major parenchymal HemorrhageLacerations through cortical Medullary junction, into collecting system
    2. Renal artery and vein injury with contained Hemorrhage
  5. Grade 5 Renal Injury
    1. Kindey shattered with multiple Lacerations
    2. Renal pedicle injury
  • Management
  • General
  1. Grade 2 Renal Injury
    1. Observation with bedrest
    2. Follow with serial Ultrasound
  2. Grade 3 Renal Injury
    1. Observation in most cases
    2. Surgical management in severe cases
  3. Grade 5 Renal Injury
    1. Manage Hemorrhagic Shock
    2. Emergent surgery
  • Management
  • Return to Play in Athletes
  1. Grade 1 Renal Injury (most common sports related Renal Injury)
    1. May return after 6 weeks of no Contact Sports IF no Hematuria
  2. Grade 2 Renal Injury
    1. Initial hospital observation
    2. No sporting activity until Hematuria clears
  • References
  1. Dreis (2020) Crit Dec Emerg Med 34(7):3-21