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. The evolution in the management of renal trauma has been made possible by advances in both imaging and minimally invasive techniques. It publishes in march, june, september and december of each year. Pdf renal artery embolization in patients with blunt renal. Renal and urogenital injuries occur in approximately 1020% of. The prevalence of renal trauma among trauma patients ranges from 0. Other times, it can only be seen through a microscope. Back to journals therapeutics and clinical risk management volume. Blunt and penetrating renal injuries are relatively uncommon, occurring in 110% of patients with trauma 14.
Pdf renal injury occurs in 1%5% of all traumas, causing disability or even death. Trauma is a leading cause of death and disability worldwide. Management of blunt and penetrating renal trauma uptodate. Pdf renal artery embolization in patients with blunt. The effect of intratympanic oxytocin treatment on rats. The kidneys are the most commonly injured genitourinary organ in children following blunt abdominal trauma. Factors predicting the outcome of nonoperative management of. Four weeks after discontinuing injections and supplements, serum creatinine was in the normal range and estimated glomerular filtration rate 1.
Although the prognosis has improved in recent decades, the mortality of aki remains considerable. Management of highgrade blunt renal trauma journal of trauma. As such, urinary leaks from either a fullthickness renal parenchyma injury or ureter injury are relative indications. Implications of augmented renal clearance on drug dosing.
Most renal injuries can be managed nonoperatively, with the management goals of controlling hemorrhage and maintaining renal function and urinary flow 1, 57. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where nonoperative management is considered. 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. This difference has been attributed to the involvement of men in highrisk activities. Department of urology, university of stellenbosch and tygerberg hospital, tygerberg, south africa. To evaluate the impact of renal artery embolization rae on renal function and blood pressure bp in patients with blunt renal trauma brt.
Despite its relatively protected retroperitoneal position, the kidney is the most commonly injured organ of the genitourinary system during trauma. Management of blunt renal trauma kurian george, salim al. The best sign of blunt kidney injury is blood in the urine hematuria. Acute kidney injury aki is a common complication in severe burns and can lead to significantly poorer outcomes.
Contemporary management of penetrating renal trauma a national. African journal of urology volume 21, issue 1, march 2015, pages 4451. Extravasation of urine is the most common complication of renal trauma. 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. Contemporary evaluation and management of renal trauma a male predominance of 3. Renal and urogenital injuries occur in approximately 1020% of abdominal trauma in adults and children. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. 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. A practical guide to evaluation and management article pdf available in the scientific world journal 4 suppl 1.
Trauma produced perinephric hematoma in two and renal artery thrombosis in one. 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 most common mechanism for renal injury is blunt trauma predominantly by. Data collected from studies published in 20072016 indicates an aki incidence in severe burns of approximately 40%.
On intensive care units, the incidence of aki reaches about 30 %. Continuous renal replacement therapy crrt is a common treatment modality of arf in critically ill patients. This study illustrates that nonoperative treatment of major renal lacerations with or without urinary extravasation is safe and effective in. We investigated the factors that increase the risk of aki and death after severe burn injury. Renal trauma is more commonly seen in young males, with a mean age of 30.
The incidence of renal artery injury and intrathoracic kidney is quite low in patients who present with blunt trauma experiencing damage. 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. Sometimes the blood can be seen with the naked eye. Contrastenhanced ct imaging revealed a complex right renal injury. 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. Kidney renal trauma is when a kidney is injured by an outside force. The kidney is the third most frequently injured organ in abdominal trauma after the spleen and liver. Jan 25, 2019 eriksson m, brattstrom o, martensson j, larsson e, oldner a 2015 acute kidney injury following severe trauma. Identifying augmented renal clearance in trauma patients. 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. Demographic and traumaspecific variables were then. A case of abdominal trauma, journal of surgical case reports, volume 2015.
Publications were limited to publish date after january 1, 2000. A systematic search was performed on embase, medline, cochrane, and pubmed for studies published up to december 2015. Oct 15, 2015 this study aimed to appraise the role of interventional radiology in children with blunt renal trauma. 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. This study aimed to appraise the role of interventional radiology in children with blunt renal trauma. There are four defined etiologies for intrathoracic kidney, which include real intrathoracic ectopic kidney, eventration of the diaphragm, congenital diaphragmatic herniation, and traumatic. Most of the renal injuries occurring as a result of blunt trauma are of low to. Contemporary evaluation and management of renal trauma. Blunt renal trauma in children with preexisting renal.
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. Pdf the kidneys are the most vulnerable genitourinary organ in trauma. Aium practice guideline for the performance of diagnostic and screening ultrasound examinations of the abdominal aorta in adults. Three patients developed hypertension following renal trauma. Implementation of continuous renal replacement therapy.
The improvements in imaging and the use of a validated renal injury grading system has helped to. The most common mechanism for renal injury is blunt trauma predominantly by motor vehicle accidents and falls, while penetrating 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. Nonneoplastic pathologic findings in nephrectomy specimens.
The measurements of renal function and bp were obtained at admission, and followed up for the. Delayed phase ct imaging is the study of choice in the diagnosis of renal urine leaks and urinomas 36. Genitourinary trauma, management of practice management. Operative and nonoperative management for renal trauma. Retrospective analysis of 126 patients with blunt trauma, treated at a regional trauma center during a year period. Full text operative and nonoperative management for renal trauma. We report our experience of the management of blunt renal trauma at our hospital between january 2007 and july 2014.
Acute kidney injury aki is a common complication of severe burns and has a high mortality rate. It is important to keep an index of suspicion for renal trauma as given by the. Blunt renal trauma accounts for 7195% of renal trauma cases. The aast classification is the most widely used system to describe renal. Review of the evidence on the management of blunt renal trauma in pediatric patients. Patients were excluded if their serum creatinine scr was greater than 1. A synthesis of prevailing thought is depicted diagrammatically in figure 2 and is summarized as follows. 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. Acute kidney injury associated with androgenic steroids.
Guideline developed in collaboration with the american college of. Review of the current management of upper urinary tract injuries by the eau trauma guidelines panel. 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. Implications of augmented renal clearance on drug dosing in. The role of interventional radiology for pediatric blunt. 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. April 2016 contemporary evaluation and management of renal trauma a male predominance of 3. 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.
Renal trauma increases risk of future hypertension urology. 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. 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. Acute kidney injury associated with androgenic steroids and. Your kidneys are guarded by your back muscles and rib cage. Two mechanisms of renal injury are described, namely blunt direct. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where nonoperative management is considered the. A young man fell off a bike and landed on his right side, resulting in severe right flank tenderness. Renal trauma management has evolved during the last decades, with a clear transition toward a nonoperative approach. Renal function and biomarkers of acute kidney injury in. In general, blunt injuries are more common, accounting for up to 90%95% of renal injuries. In general, hematuria 5 red blood cells per highpower field is present in over 95% of patients who sustain renal trauma, 1. Abdominal trauma is responsible for most genitourinary injuries. However, the absence of hematuria does not preclude significant renal injury.
But injuries can happen as a result of blunt trauma or penetrating trauma. Over an 8year period, 64 patients with brt underwent rae. 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. A fast scan focused assessment with sonography for trauma was positive. Onehundredfourteen 114 patients were treated conservatively. Kidney renal trauma is when the kidney is hurt by an outside force. There are two types of trauma blunt and penetrating trauma. Factors associated with acute kidney injury in the helsinki. The american association for the surgery of trauma aast renal injury scale should be used when injuries are reported.
However, most renal injuries are mild in severity and successfully managed conservatively. Is nonoperative management the best firstline option for high. The clinical data, injury severity score, days of hospital stay, outcomes and complications of pediatric renal trauma were recorded and evaluated. 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.
Hill, lauren bakios, jayashree krishnan, krishnan venkatesan, mohan verghese. This study illustrates that nonoperative treatment of major renal lacerations with or without urinary extravasation is safe and effective in haemodynamically stable patients. Renal injury occurs in approximately 8%10% of blunt or penetrating abdominal trauma, and 1%5% of all traumas. 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. Uremia investigation 1984 1986 clinical and experimental dialysis and apheresis 1981 1983 journal of dialysis 1976 1980 volume 1 19761977. 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. Factors predicting the outcome of nonoperative management. Imaging patients with renal impairment or risk of contrast reaction. Contemporary management of acute kidney trauma sciencedirect.
Renal trauma can cause injury to the parenchyma or renal vessels, causing. Blunt trauma damage caused by impact from an object that doesnt break the skin. 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. Although there is a consensus regarding handling of.
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