Contemporary treatment of renal trauma in Canada

Kodama, Ron

doi:10.5489/cuaj.5980

Cited by 4 publications

(3 citation statements)

References 30 publications

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“…Approximately 1-3% of all trauma patients have renal injury (1,2). Eighty percent of renal trauma is due to blunt injury (1).…”

Section: Introductionmentioning

confidence: 99%

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Endovascular embolization in renal trauma: a narrative review

Smith¹,

Eastaway²,

Hartt³

et al. 2021

Ann Transl Med

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Approximately 1-3% of all trauma patients have a renal injury. Eighty percent of renal trauma is due to blunt injury, with the remainder due to penetrating trauma which is most often iatrogenic. Contrast enhanced computed tomography is used to triage patients and offers a quick and accurate assessment of any potential organ injury. If injury is present, The American Association for the Surgery of Trauma grading system can both grade renal injuries and be used to help guide management and intervention. Grades are assigned based on imaging and clinical features of renal trauma, and have prognostic and treatment implications for patients. The objective of this narrative review is to identify optimal management of patients with renal trauma, specifically which patients can be treated with endovascular interventions following renal trauma, which can be observed, and which would be best managed surgically. For hemodynamically stable patients with renal trauma, endovascular angiography and embolization is a non-invasive approach that can be used to control bleeding and potentially avoid surgery or nephrectomy in select cases. Future research is needed to determine if a specific antibiotic regimen is needed prior to or following embolization. Further research is needed to evaluate the effectiveness of endovascular management of high-grade renal trauma (grade V). Complications of renal embolization include short-term hypertension, long term hypertension in cases of significant ischemia, acute kidney injury, and infection.

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“…Approximately 1-3% of all trauma patients have renal injury (1,2). Eighty percent of renal trauma is due to blunt injury (1).…”

Section: Introductionmentioning

confidence: 99%

“…Approximately 1-3% of all trauma patients have renal injury (1,2). Eighty percent of renal trauma is due to blunt injury (1). Penetrating trauma is often iatrogenic (i.e., renal biopsy, partial nephrectomy, tumor ablation, and nephrostomy placement) but can be due to a gunshot wound or stabbing (3).…”

Section: Introductionmentioning

confidence: 99%

Endovascular embolization in renal trauma: a narrative review

Smith¹,

Eastaway²,

Hartt³

et al. 2021

Ann Transl Med

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“…Введение. Подавляющее большинство повреждений почек (77-80%) связаны с тупой, непроникающей травмой [1]. Из них 80-85% относятся к низкой (I-III Grade OIS AAST), некритической степени тяжести (low grade), имеют только паренхиматозный раневой компонент, с последующим консервативным лечением [2].…”

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Functional range of the kidney after a low-severity injury: a randomized study

Chiglintsev,

Zyryаnov,

Chiglintsev

et al. 2023

Lučevaâ diagn. ter.

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INTRODUCTION: The basis of renal rehabilitation after trauma is restoration of blood supply and microcirculation processes.OBJECTIVE: To establish the kidneys’ functional activity indicators in the posttraumatic period using radionuclide diagnostics.MATERIAL AND METHODS: Verification of severity degree (1–3) and segmental localization of kidney trauma was carried out using radiology methods in 196 patients. Static scintigraphy was used to determine general renal function and its deficit, dynamic scintigraphy was used for renal vascularization (%), glomerular filtration rate, radiopharmaceutical transit in the parenchyma.The study was conducted in the immediate (up to 30 days) and distant (up to 6 months) periods after the injury.Statistics: Statistical analysis was performed using Statistica 6/0 software packages; Excel Microsoft Office. Under normal distribution of variables, paired Student’s t-test was used to determine differences between two independent groups. The reliability of accepted statistical estimates was at least 95%.RESULTS: The findings demonstrate that the volume of parenchyma involved in the injury and the severity of injury determine the functional activity of the kidney. Loss of total kidney function was found when the damage area involved up to 3 segments — 23.7±0.4% in the immediate period after injury, and 16.0±0.4% in the remote period. In cases of parenchymal tears, the loss of total function was 7.1±0.3%, but only in the immediate period after injury. Total blood flow in the compromised organ was significantly affected with injury of 3 segments at the studied follow-up periods, respectively: 34.9±1.0 and 41.8±0.4%. Decrease in GFR was seen in the remote post-traumatic period with maximal contusion zone (38.3±1.6 ml/min) and kidney part destruction (44.4±1.6 ml/min).DISCUSSION: In case of trauma affecting circulation with development of a local area of ischemia, arterio-venous anastomoses are involved in the preservation of blood flow to intensify the tissue blood flow. Adaptive arterial hyperemia, designed to preserve kidney function, develops. In the case of segment 1 contusion an increase in vascularization and urinary excretion of the injured organ was established. Involvement of a greater volume of parenchyma reduces the probability of blood flow shunting through arterio-venous anastomoses and leads to deepening organ ischemia. Relative decrease in main perfusion pressure is followed by the decrease of its organ component in peritubular capillaries and increase of tubular pressure as evidenced by radionuclide transit data. Correspondingly, there is a decrease of glomerular filtration rate value that is functionally dependent on blood circulation. Restoration of parameters to the normal functional range in the distant period was found only in cases restricted up to 2 damaged parts of the organ parenchyma, and steady degradation of the parameters was leading in the groups with contusion of 3 kidney segments.CONCLUSION: In case of blunt trauma of the kidney, grade 1 contusion injuries exceeding 1⁄2 the volume of the involved parenchyma entail more severe impairment of renal function than a single non-penetrating tissue ruptures of the 2nd and 3rd grade.

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