Renal injury (renal trauma)


Pelvis | Urology | Renal injury (renal trauma) (Disease)


Description

Renal injury is a destruction of the kidney tissue, blood vessels, or urinary system. The etiology is variable and includes: penetrating (eg, gunshot wounds, stab wounds), blunt which is a rapid deceleration (eg, motor vehicle crash, fall from heights); direct blow to the flank (pedestrian struck, sports injury). It may also be iatrogenic (endourologic procedures, extracorporeal shock-wave lithotripsy, renal biopsy, percutaneous renal procedures) or other causes (renal transplant rejection, childbirth that may cause spontaneous renal lacerations).

Grade I includes: contusion or non enlarging subcapsular haematoma, but no laceration ; grade II : superfical laceration < 1cm depth and does not involve the collecting system ; non expanding perirenal haematoma; grade III : laceration > 1cm, without extension into the renal pelvis or collecting system and with no evidence of urine extravasation; grade IV : laceration extends to renal pelvis or urinary extravasation; grade V : shattered kidney ; devascularisation of kidney due to hilar injury.

Causes and Risk factors

The loss of kidney function is called acute kidney injury, also known as acute renal failure (ARF). This can occur following a traumatic injury with blood loss, the sudden reduction of blood flow to the kidneys, damage to the kidneys from shock during a severe infection called sepsis, obstruction of urine flow, or damage from certain drugs or toxins. Acute kidney injury can also occur from pregnancy complications, such as eclampsia and pre-eclampsia, or related HELLP Syndrome.

Diagnosis and Treatment

Early surgical intervention is required for: reno-vascular pedicle injury, pelviureteric junction disruption, shock with signs of intraperitoneal or retroperitoneal trauma. Surgery should be performed through a midline incision and transperitoneal approach. Control of the renal pedicle should be obtained before the retroperitoneal haematoma is opened.

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