Most kidney injury (85-90% of cases) caused by blunt injuries, usually caused by car accidents, falls or assaults. Most injuries are geringgradig. The most common associated injuries involve the head, CNS, breast, spleen and liver. Penetrating injuries occur as a rule from gunshot wounds and are usually multiple intra-abdominal injuries, most connected to the breast, liver, intestines and spleen.
The kidney is injured in up to 10% of patients who have a severe and sustained abdominal trauma. In total, over 65% of gastrointestinal injuries related to the kidney. It is the most commonly injured gastroesophageal urogenital organ “Most kidney injury (85-90% of cases) caused by blunt injuries, usually caused by car accidents, falls or assaults. Most injuries are geringgradig. The most common associated injuries involve the head , the CNS, the chest, the spleen and the liver. Penetrating injuries occur as a rule from gunshot wounds and are usually multiple intra-abdominal injuries, most connected to the breast, liver, intestines and spleen. .. are renal injury to their severity in 5 classes divided (. severity of renal injury) severity of renal injury kidney injuries are classified according to their severity, as follows: Grade 1: kidney contusion and / or limited subcapsular hematoma Grad 2: Injury <1 cm deep in the recess of the adrenal medulla and the collecting system and / or limited retroperitoneal hematoma grade 3: Injury> 1 cm deep under sparing of the collection system grade 4: Injury> 1 cm deep, with the participation of Symmelsystems and / or bleeding from vascular injury grade 5: Shattered kidney and / or torn kidney vessels diagnostic urinalysis and hematocrit Clinical assessment, including repeated observation of vital signs in moderate or severe injury: contrast-enhanced CT diagnosis should in any patient m it is suspected the following conditions: Penetrating injury between the center of the chest and the abdomen significant deceleration in the accident hit on the flank In such patients, hematuria strongly suggests to kidney damage out. Other indicators are: belt sign Diffuse abdominal pressure pain sensitivity Flankenkontusionen fractures of the lower ribs patients who develop gross hematuria after a relatively minor trauma can have a previously diagnosed congenital kidney anomaly. In the laboratory, the hematocrit and the urine will be analyzed. If imaging is indicated, a CT is usually made with contrast medium to determine the extent of renal injury and identify concomitant intra-abdominal trauma and complications, including the retroperitoneal haemorrhage and Urinextravasation belong. Patients with blunt trauma and microscopic hematuria usually have minor injuries that rarely require surgical intervention. Thus, a CT is superfluous in such cases generally. A CT with a blunt trauma is displayed under the following conditions: The mechanism includes a fall from a significant height or a motor vehicle accident at high speed Severe hematuria microscopic hematuria with hypotension (systolic pressure <90 mmHg) Clinical signs point may indicate that the kidney difficult is corrupt (eg. as flank contusion, safety imprint, fractures of the lower ribs or fractures of the vertebral transverse processes) Tips and risks most patients with microscopic hematuria alone after blunt trauma do not require imaging for the diagnosis of kidney damage. The degree of hematuria does not necessarily correlate with the extent of the injury. In penetrating trauma CT comes with any severe or microscopic hematuria in question. Angiography may be indicated to assess persistent or delayed bleeding. Here is a selective arterial embolization can be performed simultaneously. Pediatric kidney injuries are similarly diagnosed, except that all children are examined with blunt trauma and a urinalysis result of> 50 erythrocytes / field by imaging. Treatment Strict bed rest with close monitoring of vital signs Surgical repair or angiographic intervention in some blunt and most penetrating injuries Most blunt renal injuries, incl. Almost all injuries 1st and 2nd degree and many injuries Grade 3 or 4 can also without active intervention be treated safely. Active intervention can be made (eg. As embolization for certain renovascular injuries) in operation or, if necessary, in stent placement or angiographic intervention. Patients must keep strict bed rest until the haematuria has subsided. Interventionist required for patients under the following conditions: Persistent bleeding (that is so strong that a treatment to hypovolemia is required..) Propagation perinephrischer hematoma Pedicle avulsion of the kidney or other significant renovascular injuries Penetrating trauma usually require surgical exploration. However, if the renal injury could be safely classified using a CT, when the blood pressure is stable and no associated intra-abdominal injuries require surgery, can wait. Important Points Most injuries of the genitourinary system affect the kidney, most arise from blunt mechanisms, and most are low grade. Begin the urological examination with urinalysis and Hct. Do a contrast-enhanced CT for suspected moderate or severe injuries (eg. As when mechanism or findings suggestive of serious injury, gross hematuria, hypotension) through. Drag a surgery or angiographic intervention for persistent bleeding, hematoma extended perinephrischem, pedicle avulsion of the kidney and significant renovascular injuries into account.