Renal trauma

Background

• Blunt mechanism 9x more common than penetrating
  • However GSW associated with higher AAST grade
• Approximately 10% blunt injuries include renal trauma

Clinical Features

• Flank pain
• Gross hematuria
• Microscopic hematuria
• Page kidney - hypertension from renal parenchyma compression by subcapsular hematoma

Differential Diagnosis

Abdominal Trauma

• Abdominal compartment syndrome
• Diaphragmatic trauma
• Duodenal hematoma
• Genitourinary trauma
• Liver trauma
• Pelvic fractures
  • Acetabular pelvic fractures
  • Open book pelvic fracture
  • Straddle pelvic fracture
  • Pelvic avulsion fracture
• Retroperitoneal hemorrhage
• Renal trauma
• Splenic trauma
• Trauma in pregnancy
• Ureter trauma

Evaluation

AAST Grading System for renal injuries

• Non-operative management
  • Grade I: Cortex contusion
  • Grade II: Cortex laceration
• Possible operative management
  • Grade III: Corticomedullary junction laceration
    • Grade IV: Collecting system laceration
• Operative management
  • Grade V: Shattered kidney, thrombosis of renal artery, avulsion of hilum

Management

• Absolute indications for renal exploration and intervention:
  • Life-threatening hemorrhage
  • Expanding, pulsatile, or non-contained retroperitoneal hematoma
  • Renal avulsion injury

Disposition

Admit

• All penetrating renal injuries
• All gross hematuria
• All grade II and higher injuries

Discharge

• Microscopic hematuria and no indication for imaging
• Isolated renal trauma and contusion-type grade I injury
  • Instruct no heavy lifting; follow up in 1-2wk to document resolution of the hematuria
• Grade I subcapsular hematoma can discharge'd with 24hr follow up

See Also

GU Trauma