trauma to the kidneys Flashcards
location of the kidneys
located deep, retroperitoneally in fossa lumbaris.
Protected by the
anteriolaterally : anterior abdominal wall & rib cage,
Post: spinal column, back muscles, ,
internallly: intraperitoneal organs.
Despite the protection, kidney injuries still occur often.
classification of types of kidney traumas
- Open – bullet wound
- Closed
- Combined – with chest or thoracic trauma, cerebral brain trauma, with trauma to the intraabdominal organs
what are the 5 mechanisms of kidney trauma
- Direct trauma to the kidney- direct blunt blow over the loin (vehicle crash, pedestrian stack, sports, for open(bullet wound)
- Indirect trauma- fracture of the ribs, fracture of the transverse processes of the vertebral bodies at T12-L3 may injure the kidneys
- Spontaneous rupture of the kidney- spontaneous rupture of hydronephrotic kidney, child birth may cause parenchymal lacerations, kidney transplant rejection
- Iatrogenic trauma- antegrade instrumentations (diagnostic- e.g percutaneous renal biopsy under ultrasound or x-ray control/pyelo-ureterography or therapeutic- percutaneous nephrolithotripsy), retrograde instrumentations ( retrograde intrarenal surgery- ureterorenoscopy(diagnostic) ureterorenoscopy plus contact lithotripsy(therapeutic). Retrograde leading to closed renal trauma- catheterisation of the ureter, double J-stenting
- Urological and non urological operations
examples of direct trauma to kidney
a direct blow over the loin e.g.
open- bullet wound
closed- car crash,
examples of indirect kidney trauma
- Fracture of the ribs,
- Fracture of the transverse processes of the vertebral bodies
examples of spontaneous trauma to the kidneys
- rupture of hydronephrotic kidney,
- child birth may causeing parenchymal lacerations,
- kidney transplant rejection
examples of iatrogenic kidney trauma
-
Antegrade instrumentations
-
diagnostic
-
percutaneous renal biopsy under ultrasound / xray
- pyelo-ureterography
-
percutaneous renal biopsy under ultrasound / xray
- therapeutic-
- percutaneous nephrolithotripsy
-
diagnostic
-
Retrograde instrumentations
- retrograde intrarenal surgery-ureterorenoscopy(diagnostic) plus contact lithotripsy(therapeutic).
- Retrograde leading to CLOSED renal trauma- catheterisation of the ureter, double J-stenting
what are the pathological forms of CLOSED kidney trauma
- Concussion of the kidney (comotio- partial damage of the renal parenchyma without macroscopic changes and therefore no clinical meaning! as it only has microscopic changes
- Contusion- there are gross macroscopic change in the renal parenchyma
- Superficial lacerations of renal parenchyma- maybe single or multiple/ e.g. child birth
-
Deep parenchyma lacerations (rupture of the kidney)- may be
- single or multiple/
- external, internal, complete/mixed
- internal = rupture of the renal fascia and formation of peri-renal uro-haematoma which may progress to retroperitoneal urohaematoma. !!
- leads to peri renal extravasation of blood and urine
- External = means communication with the collecting system of the kidney, the main symptom should be haematuria. Filling the collecting system of the kidney with blood and clots is named as- hematonephrosis
- Complete rupture
- internal = rupture of the renal fascia and formation of peri-renal uro-haematoma which may progress to retroperitoneal urohaematoma. !!
- Subcapsular hematoma( single/ multiple) – can occur during Extracorporeal Shock Wave Lithotripsy as a complication
- Avulsion of the ureter, – no clinical hematuria
- Avulsion of renal vessels – no clinical hematuria
- Avulsion of one pole of the kidney
- Pulping of the kidney- (conquassatio)
- Thrombosis of renal vessels
similarities betw/ superficial and deep parenchymal lacerations
they are star shaped as they follow the path of the renal vessels
dx betw/ internal and external deep parenchymal lacerations of the kidney
internal = caused by rupture of the renal fascia (gerota’s fascia) which leads to peri renal extravasation of blood and urine and formation of peri-renal uro-haematoma which may progress to retroperitoneal urohaematoma. !!
External = defined by a communication with the collecting system of the kidney,
the main symptom should be haematuria.
if the collecting system of the kidney is filed with with blood and clots this is called - hematonephrosis
when does perirenal hematoma progress to retroperitoneal heamatoma
if it progresses to TOTAL rupture of the renal parenchyma causing extravasation of blood and urine into the retroperitoneal space
what is avulsion
seperation from the blood vessels and protective layer
clinical features of kidney trauma
cardinal sx
Acute flank pain- loin pain or abdominal pain dull/
renal colic- due to acute obstruction/ migrating clots
Haematuria- = cardinal sxgrossly external/ complete rupture
history of renal trauma without hematuria indicates closed pathological form.
Palpable mass- due to enlargement of kidney or peri nephric hematoma
perritonial signs( irritation, rigidity) r.p. hematoma(extravasation), phlegmon, intraabdominal trama
Shock due to significant blood loss and low blood pressure
how does open renal trauma present
open wound with leakage of blood and urine
does the absence of hematuria rule out closed renal trauma
4 examples of closed renal trauma w/o hematuria (SAAP bloody urine)
no it doesn’t it rule out closed renal trauma haematuria is suggestive of closed renal trauma
Visible hematuria is only present in 35–77% of renal trauma cases. Almost half of the patients with grade II renal trauma and 30% of the patients with grade IV renal trauma have no hematuria at presentation. Visible hematuria is even less common in penetrating renal injuries.
closed renal trauma w/o hematuria
- subcapsular hematoma
- avulsion of ureter,
- avulsion of one pole of kidney
- Pulping of the kidney
