Renal Trauma or RENAL Injury Study notes for Exam
Renal trauma is due to-
- Minor injuries- blunt trauma (RTA, falls, assaults & sporting injuries)
- Major injuries – penetrating trauma (knife or gunshot wounds)
- Blunt trauma is much more common than penetrating trauma.
Clinical features of RENAL Injury
- abdominal pain especially Loin Pain which inscrease on Movements
- Hematuria is the most important sign of renal injury.
- Loin bulge due to perinephric haemtoma.
- Bruising of soft tissue in the loin.
- abdominal distension.–>in case of Retroperitoneal haematoma
- systolic blood pressure ≤90 mmHg
AAST Renal Injury Classification
1. Grade I-Renal Injury
- Contusion or non-enlarging subcapsular perirenal haematoma, and no laceration.
2. Grade II-Renal Injury
- Superficial laceration
3. Grade III-Renal Injury
- Laceration >1 cm without extension into the renal pelvis or collecting system (no evidence of urine extravasation).
4. Grade IV-Renal Injury
- Laceration extends to renal pelvis or urinary exrravasatlon.
- Vascular: injury to main renal artery or vein with contained haemorrhage.
- Segmental infarctions without associated lacerations.
- Expanding subcapsular haematomas compressing the kidney.
5. Grade V-Renal Injury
- Shattered kidney.
- Avulsion of renal hilum: devascularisation of a kidney due to hilar injury.
- Complete laceration or thrombus of the main renal artery or vein.
Investigations for Renal Injury
- Intravenous pyelography (IVP) can shows (An IVP is done urgently to assesss the damage to the kidney and to know the functioning of the other kidney)-
- Intrarenal extravasation
- Extrarenal extravasation
- Function of injured kidney
2. CT scan with contrast is the Investigation of Choice
- Blunt trauma are treated conservatively
- Penetrating injuries, small & major lacerations- Emergency surgical exploration.