Overall, approximately onefourth of solid organ injuries are due to renal trauma. Other times, it can only be seen through a microscope. The incidence of renal trauma somewhat depends on the patient population being considered. In the management of renal trauma, surgical exploration inevitably leads to nephrectomy in all but a few specialized centers. Blunt trauma damage caused by impact from an object that doesnt break the skin. The best sign of blunt kidney injury is blood in the urine hematuria. Traumatismos renales lesiones y envenenamientos manual. The conduct i determine myself by the complementary findings of examines like urografhy. American association for the surgery of trauma grade 4 renal injury substratification into grades 4a low risk and 4b high risk. In general, hematuria 5 red blood cells per highpower field is present in over 95% of patients who sustain renal trauma, 1. Diederichs and mutze, 2003 kawashima et al, 2002 meria and mazeman, 2000. Clipping is a handy way to collect important slides you want to go back to later. 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 emergency department. Pediatric renal injuries are evaluated similarly, except that all children with blunt trauma in whom urinalysis shows 50 red blood cells rbcshighpower field require imaging.
With current management options, the majority of hemodynamically stable patients with renal injuries can be successfully managed nonoperatively. The kidney is injured in up to 10% of patients who sustain significant abdominal trauma. Now customize the name of a clipboard to store your clips. Revision of current american association for the surgery of trauma renal injury grading system. Kidney renal trauma is when a kidney is injured by an outside force. Injury of the upper urinary tract and renal trauma is causes by either blunt trauma or penetrating injury. In general, blunt injuries are more common, accounting for up.
Sometimes the blood can be seen with the naked eye. Trauma is a leading cause of death and disability worldwide. Contemporary management of acute kidney trauma sciencedirect. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Renal trauma management has evolved during the last decades, with a distinct evolution toward a nonoperative approach. 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. Aast kidney injury scale dr mahmoud ibrahim mekhaimar and assoc prof frank gaillard et al. Aast kidney injury scale radiology reference article. 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. Renal trauma can cause injury to the parenchyma or renal vessels, causing bleeding, or injury to the collecting system with urine extravasation. Since accidental injuries are an important source of morbidity and mortality for children, let us take a minute to consume a morsel of info about renal trauma in children. There are two types of trauma blunt and penetrating trauma.
Most renal injuries 85 to 90% of cases result from blunt trauma. Your kidneys are guarded by your back muscles and rib cage. Renal injury occurs in approximately 8%10% of blunt or penetrating abdominal trauma, and 1%5% of all traumas. At the moment it is considered that the preservative treatment is an option in mayor of the patient with renal trauma, existing few indications for a quirurgica conduct in this type of patients. Incidence and management of penetrating renal trauma in patients with multiorgan injury. Kidney renal trauma is when the kidney is hurt by an outside force. Evaluation of renal function after major renal injury. But injuries can happen as a result of blunt trauma or penetrating trauma.
Contemporary evaluation and management of renal trauma. Among genitourinary gu tract injuries, which are rare, the kidneys are most commonly injured. The lions share of renal trauma patients are managed nonoperatively with careful monitoring, reimaging when there is any deterioration, and the use of. It is the most commonly injured gu organ from civilian external trauma. Contemporary evaluation and management of renal trauma a male predominance of 3. This difference has been attributed to the involvement of men in highrisk activities. Rodrigo donalisio da silva, md urges urologists to manage blunt and penetrating renal trauma conservatively. Complicaciones resumen inmediatas en pacientes con. Because children maintain a higher vascular tone than adults and maintain blood pressure despite high degrees of blood loss, hypotension is an insensitive sign of. The renal trauma can be life threatening in the short term, depending on the severity and the time between the onset of the injury and making the. Renal trauma may manifest in a dramatic fashion for both the patient and the clinician. Renal trauma is more commonly seen in young males, with a mean age of 30. The renal trauma can be life threatening in the short term, depending on the severity and the time between the onset of the injury and making the diagnosis. We present a revision of the renal trauma with emphasis in the radiographic evaluation, particularly ct scan that it has largely replaced the excretory urogram and arteriogram in the diagnostic worhup and management of the patient with renal trauma.