Complications following renal trauma nephrology jama. In general, hematuria 5 red blood cells per highpower field is present in over 95% of patients who sustain renal trauma, 1. Identify the key imaging features of traumarelated renal injury. Sometimes the blood can be seen with the naked eye.
An overview of the management of upper gu tract injuries, lower gu tract injury, and other gu organ injuries is provided separately. One series, with predominantly blunt mechanisms of injury, documented that 85% of patients were treated. Together with massive uncontrolled bleeding, coagulopathy, and infection, this may lead to tissue. Kidney renal trauma is when a kidney is injured by an outside force. Traumarelated continuing education and certification are recommended and an important adjunct for emergency nurses who provide care to trauma patients. Renal trauma is less common but often occurs in polytrauma. Terdapat beberapa komplikasi awal setelah cedera yaitu. We excluded case reports and articles that did not include a majority. Update practice management guideline pmg existing pmgebr. Ct is important in order to characterize and grade the renal. The aua guidelines on urological trauma were released in. The diagnosis and management of renal trauma sage journals. When a highgrade renal injury is suspected, contrastenhanced ct should be done to determine the grade of renal injury and identify accompanying intraabdominal trauma and complications, including retroperitoneal hemorrhage and urinary extravasation. The evolution in the management of renal trauma has been made possible.
This study illustrates that nonoperative treatment of major renal lacerations with or without urinary extravasation is safe and effective in haemodynamically stable patients. We performed a retrospective study of high grade blunt renal injuries at our level i trauma center to determine the indications and success of nonoperative management nom. Urogenital lesions diagnosed incidentally during evaluation for blunt renal injuries. George kasotakis, md, mph team leaders hiba abdel aziz, md, facs. The reported incidence of renal trauma varies depending on the patient population being considered. We report our experience of the management of blunt renal trauma at our hospital between january 2007 and july 2014. However, the absence of hematuria does not preclude significant renal injury. Management of renal trauma western trauma association. Renal injuries are relatively uncommon, occurring in about 1% of patients hospitalized after traumatic injury. Renal trauma trauma is most common cause of death in children injuries to the kidneys account for 60% of genitourinary injuries 90% blunt trauma usually do not require operation 1020% penetrating trauma more often require operation decelerationflexion injuries. Acute kidney injury is defined as an abrupt within 48 hours reduction in kidney func tion based on an elevation in serum creati nine level, a reduction in urine output, the need for renal replacement therapy dialy sis, or a combination of these factors. This has resulted in a paradigm shift towards managing increasingly severe blunt renal trauma with a conservative approach.
Contemporary management of acute kidney trauma sciencedirect. Current management of highgrade blunt renal trauma favors a nonoperative approach when possible. The management of renal injuries has changed over time with a tolerance for a nonoperative approach, even in the most seriously injured kidneys. Riwayat penyakit sebelumnya harus digali, apakah adanya disfungsi organ sebelum terjadinya trauma dan adanya riwayat penyakit ginjal sebelumya yang dapat memperberat trauma cachecho et al. Kidney renal trauma is when the kidney is hurt by an outside force.
Urotrauma guideline american urological association. Successful nonoperative management of highgrade blunt. But injuries can happen as a result of blunt trauma or penetrating trauma. Without prophylaxis, patients with multisystem or major trauma have a risk for dvt that exceeds 50%, and a risk of fatal pe of approximately 0. Decisionmaking difficulties still remain regarding the optimal imaging, grading and degree of interventional or. Blunt trauma damage caused by impact from an object that doesnt break the skin. Lanchon c, fiard g, arnoux v, descotes jl, rambeaud jj, terrier n, et al. Clinicians should perform diagnostic imaging with intravenous iv contrast enhanced computed tomography ct in stable blunt trauma patients with gross hematuria or microscopic hematuria and systolic blood pressure 2014 4.
Special consideration should be given to preexisting renal disease and the functioning renal mass of the trauma patient 6 x 6 giannopoulos, a. Tailoring trauma team activation tta levels and criteria. There are two types of trauma blunt and penetrating trauma. The american association for the surgery of trauma aast renal injury scale, most recently updated in 2018, is the most widely used grading system for renal trauma. Renal artery pseudoaneurysm after blunt renal trauma. The rugby factor article pdf available in current urology 83. Review of the evidence on the management of blunt renal trauma in pediatric patients. Management of blunt renal trauma kurian george, salim al. Selain itu, fasia gerota dapat pula berfungsi sebagai barrier. Patient selection is the preliminary step in adopting a nonoperative management strategy to renal trauma. The diagnosis, workup and management of blunt renal injury have evolved greatly over the past decades. Contemporary evaluation and management of renal trauma. Factors predicting the outcome of nonoperative 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 primary injury often initiates tissue necrosis with release of intracellular muscular constituents, such as creatine kinase ck and myoglobin, into the systemic circulation. Current concepts of management of renal trauma tend to promote the use of less invasive procedures and conservative management. Lucy kornblith and colleagues from san francisco general, dr. Advances in renal intervention for trauma sciencedirect. Renal artery occlusion is associated with rapid deceleration injuries.
Flank ecchymosis and broken ribs are signs suggestive of renal injury. Endovascular management of abdominal solid organ trauma. The best sign of blunt kidney injury is blood in the urine hematuria. Management of blunt and penetrating renal trauma uptodate.
Trauma is a leading cause of disability and death among young people in the developed world. In general, blunt injuries are more common, accounting for up. Known cardiac, renal or pulmonary diseases, or highrisk meds or procedures pregnancy 20 weeks morbid obesity burnstrauma combined. Aast kidney injury scale radiology reference article. Oxidative stress contributes to orthopedic traumainduced acute kidney injury in obese rats. The conservative management of renal trauma wiley online library. Evaluation and management of the elderly trauma patient. Your kidneys are guarded by your back muscles and rib cage. Delayed images should be done about 10 to 15 minutes after the initial study. The most common mechanism for renal injury is blunt trauma predominantly by motor vehicle accidents and falls, while penetrating trauma.
Contemporary evaluation and management of renal trauma a male predominance of 3. Describe the spectrum of posttraumatic renal injuries. Angela sauaia present highlights from the february 2014 issue of the journal of trauma. Blunt renal trauma accounts for 7195% of renal trauma cases. The urinary tract is commonly involved in abdominal trauma, accounting for 810% of traumarelated injuries to abdominal organs. 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. Hematuria as a predictor of abdominal injury after blunt trauma. Rodrigo donalisio da silva, md urges urologists to manage blunt and penetrating renal trauma conservatively. Primary injuries and secondary organ failures in trauma. Death and renal failure occurred in of the 230 patients without renal injury 5. The effects of treatment of renal trauma on renal function. Civilian renal injury occurs in up to 5% of trauma victims, 10, 11 and accounts for 24% of traumatic abdominal solid organ injuries. The 230 patients without renal injury had an incidence of renal failure of 7.
This difference has been attributed to the involvement of men in highrisk activities. Management and hospital outcomes of blunt renal artery injuries. Relevant articles and guidelines published between 1980 and. Since then the benefits of this approach have become increasingly apparent with reductions in nephrectomy rate, complications, and hospital stay all being reported. Other times, it can only be seen through a microscope. Severe traumatic brain injury tbi is a great economical and logistic problem in the health care system which reduces the quality of life and productivity of the patient. The trauma nursing process, taught in the tncc course, is recommended as a systematic and standardized approach for the assessment, intervention, and evaluation of the trauma patient.
Evaluation and management of blunt renal injury echoes the increasing success of nonoperative management in other blunt abdominal solid organ injury, such as liver and spleen. The prevalence of renal trauma among trauma patients ranges from 0. Renal trauma accounts for approximately 3% of trauma admissions, with blunt injuries approximately nine times more common than penetrating renal trauma. Oxidative stress contributes to orthopedic traumainduced. Citations 0 references 28 researchgate has not been able to resolve any citations for this publication. Tailoring trauma team activation ttalevels and criteria. The kidney is the most frequently injured urologic organ, with 7080% being a consequence of blunt trauma. The eau released guidelines on urological trauma including iatrogenic urological trauma and on paediatric urology with a detailed trauma section in 2014, which were updated in 2015 5,6, and on iatrogenic urological trauma in 2012 7. In the setting of blunt renal trauma and selected instances of penetrating renal trauma, a nonoperative approach may be selected. Pe is the third most common cause of death in trauma patients who survive beyond the first day 6. Wed like to understand how you use our websites in order to improve them.