INJURIES TO THE KIDNEY:

INJURIES TO THE KIDNEY: Dr.Abdulrazzaq Al-Salman
Either
1-Open (penetrating ) injury,which need immediate surgical intervention.or
2-Closed (blunt truma) injury.
In civilian life, injuries to the kidney result most often from either blows or falls on the loin or crushing injury to the abdomen, typically in a road traffic accident. Haematuria after trivial injury to the kidney should suggest the possibility of a pre-existing disease, e.g. calculus,hydronephrosis or tuberculosis.The degree of injury varies considerably from a small subcapsular haematoma to a complete tear through the kidney .

Types of closed renal trauma: (minor(1,2,3) and major(4,5)
Grade 1:renal contusion and /or nonexpanding subcapsular haematoma.
Grade 2:laceration less than 1 cm in depth sparing the renal medulla and collecting system and/or nonexpandig retroperitoneal hematoma.
Grade 3:laceration more than 1 cm sparing the collecting system.
Grade 4:laceration more than 1 cm involving the collecting system and/or renal vessels injury with hemorrhage.
Grade 5:shattered kidney and/or avulsed renal vessels.
The kidney may be partially or wholly avulsed from its vascular pedicle; one pole may be completely detached. Closed renal injury is usually extraperitoneal.
In young children who have very little extraperitoneal fat, the peritoneum, which is closely applied to the kidney, can tear with the renal capsule, leaking blood and urine into the peritoneum .

Clinical features :(pain, hematuria, meteorism)
Pain:
Superficial soft-tissue bruising can be absent but there is local pain and tenderness.
Haematuria:
Haematuria is the sign of a damaged kidney but it may not appear until some time after the injury. Profuse bleeding may cause clot colic. Life-threatening haemorrhage is a serious risk in closed or open trauma to the kidney and should prompt careful monitoring of vital signs and urgent investigation.

Summary box 71.6