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