Lecture: Kidney trauma

Question 1

What are the mechanisms of injury in renal trauma?

Answer 1

(Blunt) Falls, MVI, falls
 Kidney and hilar directly crushed 
 Less commonly, avulsion affecting vascular structures or 
 pelvic utroteric junction (PUJ) 
(Penetrative) Stab, gunshot 
 More severe / less predictable

Question 2

What is the grading for renal traumas?

Answer 2

AAST renal injury grading scale
Grade 1: Bruise / Non expanding sub-capsular haematoma + No laceration
Grade 2: Non expanding peri-renal (tissue surrounding kidney) haematoma / Laceration <1cm
Grade 3: Cortical laceration >1cm
Grade 4: Laceration through corticomedullary junction OR segmental renal artery/vein injury with contained haematoma / partial vessel laceration / vessel thrombosis
Grade 5: Shattred kidney OR renal pedicle avulsion

Question 3

What are the clinical features of renal trauma?

Answer 3

Visible haematuria
Non-visible haematuria + one episode of hypotension
Rapid deceleration injury and/or significant associated
injuries
Flank pain
Abrasions,
Fractured ribs
Abdominal distension with/without mass and tenderness

Question 4

How is renal trauma diagnosed?

Answer 4

CT scan (assess vascular injury, parenchymal bruising or lacerations, collecting system/ureteric injury)

Question 5

What is the treatment for blunt trauma?

Answer 5

Grade 1-3 Non-operative + conservative treatment
Grade 4 Conservative + Urinary extravasation stent and/or percutaneous drainage
Grade 5 Exploration and nephrectomy (if needed)

Question 6

What is the treatment for penetrative trauma?

Answer 6

Exploration + Surgery (i.e. nephrectomy / debridement)

Question 7

What are the complications of renal trauma?

Answer 7

(Early) Bleeding, infection, perinephric abscess, sepsis
(Delayed) Bleeding, hydronephrosis, calculus formation,
chronic pyelonephritis