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Kidney (Renal) Trauma

Your kidneys are generally well protected by muscles of the back and rib cage but injuries can occur as a result of blunt or penetrating trauma. The following information should help explain why timely evaluation and proper management are critical for the best outcomes.

What happens under normal conditions?

The kidneys are paired, bean-shaped solid organs located deep in the abdomen, protected by strong back muscles and separated from the front of the abdomen by the organs of the gastrointestinal tract. Their main function is to rid the body of harmful excretory substances in the form of urine. Therefore they are vital for normal function.

What types of trauma can occur?

The kidney is the most common organ in the urinary tract to be injured by severe trauma. "Trauma" is injury caused by an external force that may be either blunt—such as a car accident—or penetrating—such as a gunshot wound. Blunt trauma injuries to the kidney may show no evidence of external injury or bruises may appear over the back or abdomen where the kidney is located. Penetrating kidney injury may also be difficult to detect. For example, the external point of entry of the bullet may be small and at a distance far enough away from the location of the kidney for it not to be a consideration.

What are the signs and symptoms of kidney trauma?

Injury to the kidney can occur either as an isolated organ injury or may be associated with injury to other organ systems. Kidney injury has been classified into five grades based upon the severity of the injury. Grade one consists of low grade injury in the form of kidney bruising and grade five represents the most severe variety associated with shattering of the kidney and tearing its blood supply.

Blood in the urine (hematuria) is probably the best indicator of blunt kidney injury to the urinary system. Hematuria may be either visible to the naked eye or found only on microscopic examination of the urine. Microscopic hematuria is easily detected with high accuracy by means of a simple dipstick test.

How is kidney trauma diagnosed?

Once injury is suspected, it is important to perform imaging studies of both kidneys to confirm clinical suspicion and determine injury severity. In past years, an X-ray called an intravenous pyelogram (IVP) was used. This consists of injecting a dye and observing it as it is excreted through the kidneys. Today, a CT scan with contrast is the investigation of choice to obtain a reliable and quick way of assessing kidney injury. Ultrasonography is another effective tool that may be utilized in the diagnosis of kidney trauma. However, it may not provide the best details of the degree of injury and may need to be supplemented by either an IVP or a CT scan.

How can it be treated?

Treatment of kidney trauma depends upon the condition of the patient, the severity of kidney injury and the presence of other injuries. If the patient's condition is stable and injury to other organ systems has been ruled out, conservative, non-surgical treatment is an option. The patient needs hospital admission and bed rest until the blood in the urine clears. He/She is monitored closely for bleeding or other problems. Even after discharge from the hospital, the patient needs to be monitored for the possibility of late bleeding from the injured kidney or development of high blood pressure as the result of the kidney injury.

Surgical exploration of the injured kidney is indicated if the patient is clinically unstable and appears to be losing a lot of blood from the kidney. Patients with other significant abdominal injuries, such as injuries to the bowel, spleen or liver, who require open operation and repair may also, at the same time undergo surgical exploration and repair of the injured kidney. The aim of surgical management is to try to repair and preserve the injured kidney. However, if it is not possible to save the kidney because it is too severely injured, surgical removal may be required.  Today, most kidney injuries are managed without surgery. Even many serious injuries can be treated with minimally invasive techniques such as angiographic embolization, which accesses the arteries of the kidneys through large blood vessels in the groin, similar to a cardiac catheterization.

Are there any complications after kidney trauma?

The most common complications are urinary leakage or delayed bleeding from the damage. Treatment of these complications depends on the patient. They may require additional procedures including endoscopy (using telescopes to access the urinary tract), angiographic embolization, or surgical management (including the possible removal of the kidney) if more conservative treatment fails.

Other complications, such as the development of an abscess surrounding the kidney, can also occur. This is treated by drainage of the infection either non-surgically with a tube placed into the abscess collection or surgical evacuation. Finally, some patients develop hypertension after significant kidney trauma. This may be treated by medications, angiographically or surgically (including removal of the kidney) if conservative treatment fails.

Reviewed January 2011

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Kidney (Renal) Trauma Glossary
  • abdomen: Also referred to as the belly. It is the part of the body that contains all of the internal structures between the chest and the pelvis.

  • abdominal: in the abdomen, the cavity of this part of the body containing the stomach, intestines and bladder.

  • abscess: An accumulation of pus anywhere in the body.

  • arteries: Blood vessels that carry blood from the heart to various parts of the body.

  • bowel: Another word for intestines or colon.

  • catheter: A thin tube that is inserted through the urethra into the bladder to allow urine to drain or for performance of a procedure or test, such as insertion of a substance during a bladder X-ray.

  • catheterization: Insertion of a narrow tube through the urethra or through the front of the abdominal wall into the bladder to allow urine drainage.

  • CT scan: Also known as computerized tomography, computerized axial tomography or CT scan. A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce cross-sectional images of the body. Shows detailed images of any part of the body, including bones, muscles, fat and organs. CT scans are more detailed than general X-rays.

  • diagnosis: The process by which a doctor determines what disease or condition a patient has by studying the patient's symptoms and medical history, and analyzing any tests performed (e.g., blood tets, urine tests, brain scans, etc.).

  • dipstick test: A measuring rod is dipped into a container to test urine for chemicals that suggest whether blood might be present and whether white blood cells might be present. This test can also show the pH (acidity) of your urine and how concentrated your urine is.

  • embolization: The surgical introduction of various substances into the circulatory system to obstruct specific blood vessels.

  • endoscopy: Procedure that utilizes an endoscope.

  • evacuation: Another word for bowel movement.

  • evacuation: Elimination of feces or urine from the body.

  • excrete: Expel liquid and solid waste from the body.

  • excretory: unwanted or undigestable matter.

  • gas: Material that results from: swallowed air, air produced from certain foods or that is created when bacteria in the colon break down waste material. Gas that is released from the rectum is called flatulence.

  • gastrointestinal: Also referred to as GI. The stomach and the intestines.

  • gastrointestinal tract: The gastrointestinal tract starts from the mouth and proceeds to the esophagus, stomach, duodenum, small intestine, large intestine, rectum and anus.

  • gene: The basic unit capable of transmitting characteristics from one generation to the next.

  • groin: The area where the upper thigh meets the lower abdomen.

  • hematuria: Blood in the urine, which can be a sign of a kidney stone or other urinary problem. Gross hematuria is blood that is visible to the naked eye. Microscopic hematuria cannot be seen but is detected on a urine test.

  • high blood pressure: Medical term is hypertension.

  • hypertension: High blood pressure, which can be caused either by too much fluid in the blood vessels or by the narrowing of blood vessels.

  • infection: A condition resulting from the presence of bacteria or other microorganisms.

  • intravenous: Also referred to as IV. Existing or occurring inside a vein.

  • intravenous pyelogram: Also referred to as IVP, intravenous urography or excretory urogram. An X-ray of the urinary tract. A dye is injected to make urine visible on the X-ray and show any blockage in the urinary tract.

  • invasive: Not just on the surface; with regard to bladder cancer, a tumor that has grown into the bladder wall.

  • invasive: Having or showing a tendency to spread from the point of origin to adjacent tissue, as some cancers do. Involving cutting or puncturing the skin or inserting instruments into the body.

  • ions: Electrically charged atoms.

  • IV: Also referred to as intravenous. Existing or occurring inside a vein.

  • IVP: Also referred to as intravenous pyelogram, intravenous urography or excretory urogram. An X-ray of the urinary tract. A dye is injected to make urine visible on the X-ray and show any blockage in the urinary tract.

  • kidney: One of two bean-shaped organs that filter wastes from the blood and discharge these waste products in urine. The kidneys are located on either side at the level of the 12th ribs toward the back. The kidneys send urine to the bladder through tubes called ureters.

  • kidneys: One of two bean-shaped organs that filter wastes from the blood and discharge these waste products in urine. The kidneys are located on either side at the level of the 12th ribs toward the back. The kidneys send urine to the bladder through tubes called ureters.

  • liver: A large, vital organ that secretes bile, stores and filters blood, and takes part in many metabolic functions, for example, the conversion of sugars into glycogen. The liver is reddish-brown, multilobed, and in humans is located in the upper right part of the abdominal cavity.

  • renal: Pertaining to the kidneys.

  • spleen: An organ in the left upper abdomen of humans and other vertebrates that helps to destroy old red blood cells, form lymphocytes and store blood.

  • urge: Strong desire to urinate.

  • urinary: Relating to urine.

  • urinary tract: The system that takes wastes from the blood and carries them out of the body in the form of urine. Passageway from the kidneys to the ureters, bladder and urethra.

  • urine: Liquid waste product filtered from the blood by the kidneys, stored in the bladder and expelled from the body through the urethra by the act of urinating (voiding). About 96 percent of which is water and the rest waste products.

  • urology: Branch of medicine concerned with the urinary tract in males and females and with the genital tract and reproductive system of males.

  • vas: Also referred to as vas deferens. The cordlike structure that carries sperm from the testicle to the urethra.

Kidney (Renal) Trauma Anatomical Drawings

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