Renal trauma

Renal trauma can result from direct, blunt, penetrating and iatrogenic injury.

Renal injuries account for ~10% of abdominal trauma, and thus the demographic of affected individuals reflects that population. The incidence of renal injuries increases in pre-existing congenital or acquired renal pathology (e.g. horseshoe kidney, renal cysts).

Patients tend to present with microscopic or macroscopic hematuria and flank and/or abdominal pain. In more severe cases, hypotension and shock may be present.

The vast majority of isolated renal trauma are minor (95-98%), the low incidence of major renal injuries is explained by the favourable anatomic position of the kidneys, which are located in retroperitoneum.

Imaging generally should be reserved for haemodynamically stable patient; those who are haemodynamically unstable are often taken directly to the operating theatre.

Aetiology

Blunt trauma from motor vehicle collisions, falls, and personal collisions are the leading cause of renal injury (~85%), the mechanism is from deceleration injuries from a collision of the kidney with the vertebral column or thoracic cage.

Iatrogenic injuries can result from surgery, percutaneous renal biopsy, nephrostomy and extracorporeal shock wave lithotripsy (ESWL).

Types

The vast majority (95-98%) of renal injuries are minor. The spectrum of renal injuries include:

Associations

Serious renal injuries from blunt and penetrating trauma are associated with multi-organ injuries in ~80% of cases 5.

Ultrasound

May detect haemoperitoneum but is not as accurate in CT at diagnosing renal parenchymal injuries 5.

CT

CT is the mainstay in diagnosing renal injuries:

  • CT multiphase protocol study for suspected renal trauma includes a non-contrast phase, an arterial phase to evaluate vascular injury, a nephrographic phase to evaluate renal parenchymal lesions and a delayed phase to evaluate bleeding and collecting system injuries
  • an alternative protocol study is a portal venous phase followed by a delayed phase to assess for collecting system injury 5

See main article renal trauma grading for a detailed description of the AAST classification of renal injuries.

Angiography

CT can provide most of the information required regarding vascular injuries, but angiography can be used to further delineate the area of injury as well as offering the opportunity for treatment with angioembolisation 5.

Complications affect ~7.5% (range 3-10%) of renal injuries 4-5:

Renal tumours can spontaneously haemorrhage, and cause perinephric fluid collection of blood density. These include:

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Article information

rID: 24681
Section: Pathology
Synonyms or Alternate Spellings:
  • Renal trauma
  • Renal laceration
  • Traumatic renal injuries
  • Renal injuries
  • Renal contusion
  • Avulsion of renal pedicle
  • Renal haemorrhage
  • Renal injury

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Cases and figures

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    Case 1: traumatic rupture (gross pathology)
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    Injury to the cal...
    Case 2
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    Case 3: renal artery thrombosis (CT)
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    Case 3: renal artery thrombosis (DSA)
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    Case 4: renal artery pseudoaneurysm (DSA)
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    Case 4: renal artery pseudoaneurysm (CT)
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    Case 5: Grade II
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    Case 6; subcapsular haematoma
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    Case 7
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    Case 8: grade V
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    Case 9: perinephric haematoma
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    Case 10: laceration with urine leak
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    Case 11: with haemorrhage into renal cyst
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    Case 12: perinephric haematoma and urine leak
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