Renal Trauma

Subtitle of topic

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 Learning Objectives
 To understand the etiology of renal trauma
 To understand the pathophysiology of renal trauma
 When and How to investigate a patient with suspected renal
trauma

 Management of Renal Trauma

 Complications of renal trauma

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 What Protects The Kidneys?
 The Rib cage
 Muscles
 Fat

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 Incidence
 The kidneys are the most common genitourinary organ injured
from external trauma

 Renal injuries occur in 10% of all cases of abdominal trauma

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 Etiology
Blunt Trauma

Penetrating Trauma

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 Blunt Trauma

Accidents– Vehicular accidents

Assaults-- Physical assaults

Acceleration– Deceleration
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 Deceleration Injury

Fixed
Momentum
Points

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 Deceleration Injury
• Renal vein disruption
• Renal artery
Renovascular thrombosis
• Renal pedicle avulsion

• Avulsion
UPJ

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 Deceleration Injury + Renal Artery
Thrombosis

Deceleration Injury

Compression of renal artery between

abdominal wall and vertebral bodies

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 Deceleration Injury + Renal Artery
Thrombosis

Kidney
moves

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 Deceleration Injury + Renal Artery
Thrombosis

Kidney Renal artery

moves is fixed

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 Deceleration Injury + Renal Artery
Thrombosis
Tear of the
Kidney Renal artery
non elastic
moves is fixed
intima

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 Deceleration Injury + Renal Artery
Thrombosis
Tear of the
Kidney Renal artery
non elastic
moves is fixed
intima

Hemorrhage
in vessel
wall

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 Deceleration Injury + Renal Artery
Thrombosis
Tear of the
Kidney Renal artery
non elastic
moves is fixed
intima

Hemorrhage
Thrombosis in vessel
wall

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 Penetrating Trauma
Gunshots

Stab

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 Presentation
Major Abdominal Trauma

Asymptomatic

Shock

Hematuria

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 Patients with Trauma
 What caused the Trauma?
 Severity of impact?
 Site of Injury

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 Patients with Trauma

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  A – Airway ( with cervical spine protection)
 B– Breathing
 C– Circulation + Control of Bleeding
 D– Disability ( Neurologic status)
 E– Exposure ( Undress)
 E– Environment ( Temperature Control)

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 When to Suspect Renal Trauma?
 Gross Hematuria
 Shock + Microscopic Hematuria
 Severe deceleration Injury
 Injury to Upper Abdomen / Lower Chest
 Penetrating Injury along Anterior Axillary Line
 More Likely to damage Renal pedicle and renal hilum
 Penetrating Injury along Posterior Axillary Line
 More Likely to damage parenchyma
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 When is Hematuria Absent?
 7% of Grade IV Injuries
 (Shariat et al 2008)

 36% of Renal vascular Injuries

 (Cass 1989)

 50% of UPJ Disruptions

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 No Relation Between

Degree of Severity of
Hematuria Renal Injury

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