This study aimed to appraise the role of interventional radiology in children with blunt renal trauma. Blunt renal trauma in children with preexisting renal. The most common mechanism for renal injury is blunt trauma predominantly by motor vehicle accidents and falls, while penetrating trauma. Review of the current management of upper urinary tract injuries by the eau trauma guidelines panel. Ct is the most informative radiologic study in renal trauma and is the examination of choice in patients suspected of having serious renal injuries or associated injuries amenable to ct evaluation. Operative and nonoperative management for renal trauma. Implications of augmented renal clearance on drug dosing in. However, the absence of hematuria does not preclude significant renal injury. Sometimes the blood can be seen with the naked eye. Abdominal trauma is responsible for most genitourinary injuries.
Renal trauma patients are largely managed conservatively but on occasion have to be embolised or taken to theatre for definitive surgical management, usually in the form of emergency nephrectomy. However, most renal injuries are mild in severity and successfully managed conservatively. Contemporary evaluation and management of renal trauma. Guideline developed in collaboration with the american college of. The evolution in the management of renal trauma has been made possible by advances in both imaging and minimally invasive techniques. Nonneoplastic pathologic findings in nephrectomy specimens. The aast classification is the most widely used system to describe renal. Factors predicting the outcome of nonoperative management of. Aium practice guideline for the performance of diagnostic and screening ultrasound examinations of the abdominal aorta in adults. A synthesis of prevailing thought is depicted diagrammatically in figure 2 and is summarized as follows.
Implementation of continuous renal replacement therapy. Identifying augmented renal clearance in trauma patients. Jan 25, 2019 eriksson m, brattstrom o, martensson j, larsson e, oldner a 2015 acute kidney injury following severe trauma. A case of abdominal trauma, journal of surgical case reports, volume 2015. Management of blunt and penetrating renal trauma uptodate.
Renal trauma is more commonly seen in young males, with a mean age of 30. Renal function and biomarkers of acute kidney injury in. Acute kidney injury aki and renal failure arf are the major challenges during critical illness and represent a strong and independent risk factor for mortality. It is important to keep an index of suspicion for renal trauma as given by the. As such, urinary leaks from either a fullthickness renal parenchyma injury or ureter injury are relative indications. Pdf the kidneys are the most vulnerable genitourinary organ in trauma. A subsequent ct scan showed that the nail was positioned within the transverse colon with free air and fluid surrounding the liver, spleen and paracolic gutters, and a perforation of the. The kidney is the third most frequently injured organ in abdominal trauma after the spleen and liver. Blunt renal trauma accounts for 7195% of renal trauma cases. Nowadays, ct plays a major role in investigation of renal trauma and is currently the imaging modality of choice. Delayed phase ct imaging is the study of choice in the diagnosis of renal urine leaks and urinomas 36. We present an overview of renal trauma as illustrated by three interesting cases of blunt renal trauma who presented in quick succession of each other to the. Blunt and penetrating renal injuries are relatively uncommon, occurring in 110% of patients with trauma 14.
Retrospective analysis of 126 patients with blunt trauma, treated at a regional trauma center during a year period. A fast scan focused assessment with sonography for trauma was positive. Renal vein plasma renin activity pra from the traumatized kidney was three to eight times greater than renal vein pra from the untraumatized contralateral kidney. The trauma registry from a level i trauma center was searched over a 6year period january 1, 2007, to december 31, 2012 for all patients with renal injuries, including those with and without urinary leak. Extravasation of urine is the most common complication of renal trauma. A systematic search was performed on embase, medline, cochrane, and pubmed for studies published up to december 2015. Acute kidney injury aki is a common complication of severe burns and has a high mortality rate. Most of the renal injuries occurring as a result of blunt trauma are of low to. Since the early 1960s, the prognosis of patients with severe burns and aki has improved significantly although mortality remains high up to 45% 3,4,5.
Contemporary evaluation and management of renal trauma a male predominance of 3. Factors associated with acute kidney injury in the helsinki. African journal of urology volume 21, issue 1, march 2015, pages 4451. Though the retroperitoneal location affords the kidneys some protection from the forces experienced in blunt abdominal trauma, the kidneys are at greater risk of injury when a disease process exposes them from their normal shielded location. The best sign of blunt kidney injury is blood in the urine hematuria. Continuous renal replacement therapy crrt is a common treatment modality of arf in critically ill patients. Three patients developed hypertension following renal trauma.
Review of the evidence on the management of blunt renal trauma in pediatric patients. In general, hematuria 5 red blood cells per highpower field is present in over 95% of patients who sustain renal trauma, 1. Implications of augmented renal clearance on drug dosing. Contrastenhanced ct imaging revealed a complex right renal injury. The most common mechanism for renal injury is blunt trauma predominantly by. Nov 23, 2015 augmented renal clearance arc has been reported in approximately 3065% of patients in the intensive care unit icu despite the presence of a normal serum creatinine concentration. Back to journals therapeutics and clinical risk management volume. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where nonoperative management is considered the.
Department of urology, university of stellenbosch and tygerberg hospital, tygerberg, south africa. Is nonoperative management the best firstline option for high. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where nonoperative management is considered. We investigated the factors that increase the risk of aki and death after severe burn injury. Oct 15, 2015 this study aimed to appraise the role of interventional radiology in children with blunt renal trauma. Acute kidney injury aki, previously called acute renal failure, is characterized by an abrupt increase in the concentration of serum creatinine scr and nitrogenous waste products and by the inability of the kidney to appropriately regulate fluid and electrolyte homeostasis. In group 3, auditory brainstem response thresholds increased significantly on day 1 after acoustic trauma, but there were no significant differences between thresholds at baseline and on the 7th and 21st days. There are two types of trauma blunt and penetrating trauma. Renal injury occurs in approximately 8%10% of blunt or penetrating abdominal trauma, and 1%5% of all traumas.
Your kidneys are guarded by your back muscles and rib cage. A young man fell off a bike and landed on his right side, resulting in severe right flank tenderness. Although the prognosis has improved in recent decades, the mortality of aki remains considerable. Acute kidney injury aki is a common complication in severe burns and can lead to significantly poorer outcomes. Genitourinary trauma, management of practice management. Management of blunt renal trauma kurian george, salim al. Data collected from studies published in 20072016 indicates an aki incidence in severe burns of approximately 40%. A plain abdominal radiograph confirmed the presence of a single nail in the abdomen. We present an overview of renal trauma as illustrated by three interesting cases of blunt renal trauma who presented in quick succession of each other to the emergency department. In general, blunt injuries are more common, accounting for up to 90%95% of renal injuries. Trauma produced perinephric hematoma in two and renal artery thrombosis in one. On intensive care units, the incidence of aki reaches about 30 %. Pdf renal injury occurs in 1%5% of all traumas, causing disability or even death.
Urinomas occur in 1%7% of cases and consist of a collection of urine that may be encapsulated, although they can also manifest as free fluid. Apr 23, 2016 severe renal injuries are usually associated with multisystem injuries, may require interventional radiology to control hemorrhage and improve the chances for renal salvage, and are more likely to fail nonoperative management. Other times, it can only be seen through a microscope. Despite its relatively protected retroperitoneal position, the kidney is the most commonly injured organ of the genitourinary system during trauma. First, the accumulative knowledge about the safety and outcome of the renal trauma nonoperative approach, 1 17 and also for the management of other internal organs like the spleen. It publishes in march, june, september and december of each year. This difference has been attributed to the involvement of men in highrisk activities. In group 1, auditory brainstem response thresholds increased significantly after acoustic trauma.
The effect of intratympanic oxytocin treatment on rats. Hill, lauren bakios, jayashree krishnan, krishnan venkatesan, mohan verghese. Most renal injuries can be managed nonoperatively, with the management goals of controlling hemorrhage and maintaining renal function and urinary flow 1, 57. Pdf renal artery embolization in patients with blunt. Methods consecutive trauma patients who were admitted to the intensive care unit between march 2015 and january 2016 and had a measured creatinine clearance crcl were considered for inclusion. Trauma is a leading cause of death and disability worldwide. Renal trauma increases risk of future hypertension urology. Factors associated with acute kidney injury in the.
Pdf renal artery embolization in patients with blunt renal. A practical guide to evaluation and management article pdf available in the scientific world journal 4 suppl 1. Publications were limited to publish date after january 1, 2000. Four weeks after discontinuing injections and supplements, serum creatinine was in the normal range and estimated glomerular filtration rate 1. The clinical data, injury severity score, days of hospital stay, outcomes and complications of pediatric renal trauma were recorded and evaluated. Contemporary management of penetrating renal trauma a national. Management of highgrade blunt renal trauma journal of trauma. Contemporary management of acute kidney trauma sciencedirect. We report our experience of the management of blunt renal trauma at our hospital between january 2007 and july 2014. Demographic and traumaspecific variables were then. Arc was defined as a measured crcl of mlmin or greater. On axial images, the devascularised lower renal pole fragment could not be easily appreciated as it was surrounded by a haematoma. This study illustrates that nonoperative treatment of major renal lacerations with or without urinary extravasation is safe and effective in haemodynamically stable patients. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries.
Onehundredfourteen 114 patients were treated conservatively. Acute kidney injury associated with androgenic steroids and. But injuries can happen as a result of blunt trauma or penetrating trauma. The improvements in imaging and the use of a validated renal injury grading system has helped to. This study illustrates that nonoperative treatment of major renal lacerations with or without urinary extravasation is safe and effective in. Over an 8year period, 64 patients with brt underwent rae. The incidence of renal artery injury and intrathoracic kidney is quite low in patients who present with blunt trauma experiencing damage. Although there is a consensus regarding handling of. April 2016 contemporary evaluation and management of renal trauma a male predominance of 3. The american association for the surgery of trauma aast renal injury scale should be used when injuries are reported. High grade renal trauma due to blunt injury in children. The measurements of renal function and bp were obtained at admission, and followed up for the. Patients were excluded if their serum creatinine scr was greater than 1. Factors predicting the outcome of nonoperative management.
Uremia investigation 1984 1986 clinical and experimental dialysis and apheresis 1981 1983 journal of dialysis 1976 1980 volume 1 19761977. Acute kidney injury associated with androgenic steroids. Full text operative and nonoperative management for renal trauma. Blunt renal injuries are the cause of greater than 90% of renal injuries in children, and the kidney is the most common organ injured in blunt abdominal trauma.
The role of interventional radiology for pediatric blunt. Severe renal injuries are usually associated with multisystem injuries, may require interventional radiology to control hemorrhage and improve the chances for renal salvage, and are more likely to fail nonoperative management. Kidney renal trauma is when a kidney is injured by an outside force. Kidney renal trauma is when the kidney is hurt by an outside force. The prevalence of renal trauma among trauma patients ranges from 0. Inclusion criteria were 1 original research articles regarding management of pediatric blunt renal trauma, 2 involvement of cases of highgrade renal grades iv and v trauma, and 3 more than one patient presented per study. Imaging patients with renal impairment or risk of contrast reaction. Blunt trauma damage caused by impact from an object that doesnt break the skin. Original article factors predicting the outcome of nonoperative. Renal trauma management has evolved during the last decades, with a clear transition toward a nonoperative approach. To evaluate the impact of renal artery embolization rae on renal function and blood pressure bp in patients with blunt renal trauma brt. Renal and urogenital injuries occur in approximately 1020% of.
Renal in juries were graded by the american association. Renal and urogenital injuries occur in approximately 1020% of abdominal trauma in adults and children. There are four defined etiologies for intrathoracic kidney, which include real intrathoracic ectopic kidney, eventration of the diaphragm, congenital diaphragmatic herniation, and traumatic. The kidneys are the most commonly injured genitourinary organ in children following blunt abdominal trauma. Renal trauma can cause injury to the parenchyma or renal vessels, causing. Two mechanisms of renal injury are described, namely blunt direct. Augmented renal clearance arc has been reported in approximately 3065% of patients in the intensive care unit icu despite the presence of a normal serum creatinine concentration.
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