Kidney contusion: signs, diagnosis, treatment, consequences
The content of the article:
- Etiology and pathogenesis
- Features of injury in childhood
-
Kidney injury symptoms
- Hematuria
- Urohematoma and perirenal hematoma
- First aid
- Diagnostics
- Kidney injury treatment
- Further observation
- Complications
- Forecast
- Video
Kidney injury occurs as a result of injury - falling from a height, car accident, impact. Trauma can be life-threatening, but usually only conservative treatment is required.
Kidney injury is the result of a blow, fall from a height, or other injury
Damage is more common in young and middle-aged men. It also occurs in children, accounting for 10 to 12% of all cases. Simultaneous injury to both organs is rare; the right and left kidneys are injured with the same frequency.
Distinguish between closed and open kidney damage. The latter are usually associated with wounds and are rare. Isolated injuries are recorded in 65% of cases, the rest is associated with combined injuries with other organs.
Etiology and pathogenesis
Kidney injury from a fall from a height or as a result of exposure to a blast wave occurs as a result of shock. In this case, the traumatic force is directed directly to the organ area. Compression or impact may also cause damage.
With a single impact, for example by a car bumper, the renal parenchyma may rupture. In this case, the fibrous capsule is often damaged.
The degree of traumatic impact is determined not only by its strength and nature, but also by other factors, including:
- age;
- anatomical features, including the type of branching of the renal vessels and the shape of the organ;
- the condition of the perineal and subcutaneous tissue, as well as the muscles;
- intraperitoneal pressure;
- filling the intestines.
Features of injury in childhood
With blunt trauma in children, the kidneys are damaged much more often than other organs of the genitourinary system. This is due to the anatomical features of the child's body.
In children, kidney injury is more common than other organs of the genitourinary system.
Compared to the structure of an adult, the kidneys in a child are proportionally much larger. They are less protected from trauma by Gerot's fascia and perirenal tissue. The abdominal muscles are usually underdeveloped and also present a weak defense.
In children, the fixation apparatus of the kidney is imperfect, so it is more mobile. It is fixed only by the vascular pedicle and the ureter, so it can easily move with sharp acceleration or deceleration. As a result, tears of the ureter may occur. This type of injury is often observed as a result of falls from a height or during road traffic accidents with hard braking.
Due to the lobular structure of the organ, which is characteristic of infants and young children, the renal parenchyma can be easily damaged. The two lower ribs of the child are flexible and soft and do not provide adequate protection.
Kidney injury symptoms
The main signs of a bruised kidney are pain in the side, lower back and abdomen, swelling in the area of the organ (perirenal hematoma and / or urohematoma) and hematuria.
The main symptom of a bruise is pain in the injured area.
Other possible violations:
- abrasions on the lateral surface of the abdomen, ecchymosis on the skin;
- feeling of heaviness in the abdominal cavity;
- fractured ribs.
All symptoms occurring at the same time are rare.
With severe contusion and concomitant injury, oliguria is noted in the first five days. In more severe cases, as well as in patients with severe shock, anuria may develop. During the first three days after the injury, the body temperature may rise. This is a sign of acute traumatic pyelonephritis.
Against the background of combined bruises, the clinical picture is more diverse, which complicates the diagnosis. Combined injuries with abdominal organs are of particular difficulty.
Hematuria
Hematuria is one of the most characteristic symptoms and is observed in 95–98% of cases. It may be absent when the ureter is blocked by a blood clot or the vessels of the ureter or kidney are torn off.
The intensity of this symptom is not a factor determining the degree of injury, but prolonged profuse hematuria is a sign of serious injury.
Urohematoma and perirenal hematoma
Swelling and pain in the area of the organ is associated with 5-15% of cases of damage. In some patients, a hematoma can only be detected 2-3 days after injury.
With a significant perineal hematoma, irritation of the peritoneum is noted. The pain can be caused not only by a contusion of the kidney itself, but also by a concomitant injury to the ribs or other organs.
First aid
In case of injury, to a large extent, an ambulance must be called immediately. The team members should find out from the victim (provided that he is conscious) the cause and details of the injury that occurred.
In case of severe injuries, it is important to provide first aid in a timely manner.
If possible, measures should be taken to assess the condition and, if necessary, the patient should be transported to the hospital as soon as possible.
Diagnostics
The contusion is diagnosed taking into account the data of the anamnesis, general and local symptoms. To determine the severity of the injury, the following studies may be prescribed:
- Ultrasound (ultrasound);
- CT (computed tomography);
- retrograde pyelography;
- survey and excretory radiography;
- radioisotope scintigraphy;
- renal angiography.
Computed tomography is performed to clarify the diagnosis
The general condition of the patient, the presence of a second kidney and its function are assessed.
Urinalysis is of great diagnostic value
On the echograms in the damaged organ, focal changes are recorded. If there is a urohematoma or perirenal hematoma, there are changes in the retroperitoneal tissue.
Lack of kidney function can also occur with minor trauma. This occurs when the ureter and renal pelvis are blocked by blood clots. In this case, a clinical picture characteristic of renal colic should be observed.
When diagnosing concomitant bruises with abdominal organs, laparoscopy can be prescribed.
Kidney injury treatment
Treatment is determined by the severity of the injury and the presence / absence of injuries to other organs. An uncomplicated isolated bruise can be treated at home. Therapy includes adherence to strict bed rest for a period of 2 to 6 weeks, hemostatic therapy and the use of antibacterial drugs.
One of the important factors in successful treatment is adherence to bed rest.
In cases of significant subcapsular, long-term non-absorbable hematoma, which causes ischemia and compression of the renal parenchyma, it may need to be removed.
The indication for surgical treatment is rupture of the parenchyma (with damage of the II and III degrees). The operation must be carried out with the preservation of the organ. Subject to removal:
- urohematoma or perirenal hematoma;
- areas of the parenchyma in which there is a violation of the blood supply.
The breaks are sutured, the retroperitoneal space is drained. If there is an infection, a nephrostomy is done.
If the perirenal hematoma increases simultaneously with the increase in the symptoms of anemia, the operation is carried out for health reasons. Usually, threatening bleeding is noted with crushing of the kidney, separation of the organ from the renal pedicle. In such cases, in the absence of impaired renal function of the second organ, nephrectomy is prescribed.
Further observation
For minor bruises, an active lifestyle is allowed after about 6 weeks. Complete removal of restrictions is possible only after the disappearance of microhematuria.
After a bruise, medical supervision is necessary throughout the year.
Throughout the year, it is periodically necessary to determine blood pressure, undergo an ultrasound of the kidneys and (according to indications) CT or urography, and take a urine test.
Complications
Post-traumatic complications of kidney injury are subdivided as follows:
| Complications | Description |
| Early | The greatest danger is such disorders as: secondary bleeding, thrombosis of the renal vein and / or artery with the subsequent development of renal infarction. Renal angiography plays a major role in recognizing these effects. |
| Late | These include: hydronephrosis, post-traumatic cysts, chronic pyelonephritis, nephrolithiasis. These complications can occur with nephrogenic arterial hypertension (most often observed in young men) |
In rare cases, a pseudoaneurysm is formed. At the same time, a minimal invasive method of treatment is shown - embolization using a catheter.
Forecast
The prognosis in patients with isolated injuries, in the case of their timely diagnosis and treatment, is favorable. Renal function is determined by the severity of the injury, the presence of complications, and the degree of subsequent nephrosclerosis.
If the patient had a concomitant injury that affected other abdominal organs, the prognosis is significantly worse.
Video
We offer for viewing a video on the topic of the article.
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
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