Renal Trauma: A Practical Guide to Evaluation and Management

Abstract

DOMAIN: urology INCIDENCEAt major urban trauma centers, the kidneys are injured in <5 % of all trauma cases. Renal trauma comprises about half of all genitourinary trauma. Since at most trauma centers blunt trauma is more common, blunt renal injuries thus occur as often as nine times as often as penetrating injuries. 1 Both kidneys are at equal disposition for injury.

Kidney and uro-trauma: WSES-AAST guidelines

“…A group of experts in the field coordinated by a central coordinator was contacted to express their evidence-based opinion on several issues about the pediatric (< 16 years old) and adult urogenital trauma [12, 13]. Urogenital trauma was assessed by the anatomy of the injury (kidney, urogenital tract, bladder), type of injury (blunt and penetrating injury), management (conservative and operative management), and type of patient (adults, pediatrics).…”

“…Special attention should be given to pelvic trauma in which urethral injuries can be frequently missed but should ideally be diagnosed in the first hours [1]. Macro or micro-hematuria is frequently present (88-94%) in cases of renal/urogenital trauma but it does not predict the grade of injury [13, 14]. Macro-hematuria is more frequently associated with major renal injuries; however, in 10–25% of high-grade kidney injury hematuria is, the same being observed in 24–50% of ureteropelvic junction and renal hilum injuries [13, 15].…”

“…Macro or micro-hematuria is frequently present (88-94%) in cases of renal/urogenital trauma but it does not predict the grade of injury [13, 14]. Macro-hematuria is more frequently associated with major renal injuries; however, in 10–25% of high-grade kidney injury hematuria is, the same being observed in 24–50% of ureteropelvic junction and renal hilum injuries [13, 15]. In 0.1–0.5% of the patients, hemodynamic stability and micro-hematuria exist in the presence of a significant urinary tract injury [5, 16–18].…”

“…However, while micro-hematuria (< 50 red blood cells (RBC) per high-power field (HPF)) is frequent in children due to the kidney anatomy and the presence of undiagnosed kidney diseases (1–36%), macro-hematuria seems to be more related to major renal injuries [22, 24]. The general suggestion is to perform imaging investigation in all those patients with blunt trauma with > 50 RBCs/HPF [13, 22]. In order to refine the use of CT scan in children, however, other factors should be considered (i.e., mechanism of injury and its energy/degree of deceleration associated with physical findings such as hypotension, flank hematoma and ecchymosis, rib fractures, cutaneous signs in the abdomen, and a drop in hematocrit associated with any degree of hematuria) [3, 13, 14, 17, 19–22, 24–34].…”

Klinische Vorgehensweise bei Nierentraumata

“…Bei größeren arteriellen Verletzungen kann die Niere lediglich in einem geringen Anteil erhalten werden. Bei Abriss der Nierengefäße ist davon auszugehen, dass sich die Niere nicht erhalten lässt und nephrektomiert werden muss, insbesondere da meist eine prolongierte Ischämie vorliegt, die eine komplette sekundäre Parenchymschädigung wahrscheinlich macht [1,2,5,6,16]. …”