What Is Kidney Trauma?
Kidney trauma is the injury occurring from an external matter. Renal trauma can damage the renal vasculature and the parenchyma, which can cause internal bleeding and leakage of urine. Kidney trauma can cause arterial dissection, devascularized kidneys due to thrombosis, and avulsion of renal vessels. There are two types of kidney trauma, namely:
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Blunt Trauma - Blunt trauma is the trauma that causes injury to the kidneys without breaking the skin. It can result from falls, accidents, and sports activities like boxing, football, and hockey. Blunt trauma is diagnosed by hematuria (presence of blood in urine). It can result from a direct blow to the organ, rapid deceleration forces, or crushing of the organ against the paravertebral muscles.
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Penetrating Trauma - The trauma from an object causing the injury breaks in the skin. For example, injury from a knife is a source of penetrating trauma. Penetrating trauma can be identified by the presence of a wound from a knife, bullet, or other objects that have pierced the skin.
What Are the Functions of the Kidney?
Kidneys are a pair of organs present in the body's pelvic region. They are the filter system of the body. Each of them consists of millions of filtering units called nephrons. The nephrons selectively reabsorb the waste products from the blood to form urine and return needed substances to the blood. Each nephron consists of a glomerulus and a tubule. Blood flows into the kidneys via the renal artery.
The kidney’s primary function is to filter out the blood and produce urine. The filtration rate of the blood per minute through the glomerulus is called the glomerular filtration rate (GFR). The filtration process removes the acid produced in the body and maintains the water, salts, and minerals such as sodium, calcium, potassium, and phosphorus balance. The urine consists of all the waste products from the blood and an extra amount of water. Urine travels from the kidneys via ureters to the urinary bladder. The urinary tract consists of two kidneys, two ureters, a bladder, and a urethra. Damage to the kidneys can cause loss of function, leading to decreased urine production, retention of waste products inside the body, and loss of protein and blood in the urine.
This damage results in painful urination, low urine output, and hematuria. Functions of the kidney include -
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Fluid balance.
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Electrolyte balance.
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Removal of waste products from the blood into the urine.
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Regulation of blood pressure by releasing hormones.
What Are the Symptoms of Kidney Trauma?
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Hematuria - Blood in the urine is hematuria.
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Abdominal Pain - Pain in the abdomen is experienced in trauma to the kidneys.
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Lower Back Pain - Pain in the region of the kidneys is found in patients with renal trauma.
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Signs of Internal Bleeding - Decreased urine output, fatigue, dizziness, and low blood pressure are the symptoms of internal bleeding.
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Difficulty Urinating - Injury to the urinary tract can cause difficulty in urination.
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Fever - Internal bleeding can cause a rise in the body's temperature.
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Shock - A condition caused by a sudden drop in blood pressure resulting from trauma.
How to Diagnose Kidney Trauma?
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Urine Tests - A urine test can be done to detect the presence of blood in the urine that is hematuria.
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Imaging Techniques - Imaging techniques can be used to study the kidneys' structure. It should be included in the following-
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Blunt abdominal trauma with or without hemodynamic instability.
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Penetrating trauma to the chest, pelvis, and abdomen.
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Injurious based upon the mechanism and clinical examination.
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Computed Tomography (CT) - A CT scan can be used to study the internal structures of the kidney to understand the extent of the injury. A CT scan makes X-ray images which are then put together to show the parts of the body.
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Renal Ultrasound - Kidney ultrasound uses sound waves to detect kidney trauma. The sound waves bounce back from the structures in the body to create images.
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Intravenous Pyelogram - Intravenous pyelogram uses a specialized dye to assess kidney functioning. X-rays are used to check the movement of the dye in the urinary system. The dye is injected into the bloodstream intravenously.
How to Treat Symptoms of Kidney Trauma?
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Non-operative Treatment - Non-operative management in patients with hemodynamically stable renal trauma has a better overall prognosis. Non-operative management has been proven a success due to the advancement in computerized tomography imaging, which helps classify renal injury. The improvement in the technique of angioembolization has also helped in non-operative management. Renal functions can be preserved by the initial non-operative approach, which includes supportive care in the intensive care unit (ICU), serial clinical examinations, serial hematocrit every six to eight hours, transfusion of blood products, and angioembolization, and drain placement for urine leakage.
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Operative Treatment - Patients who fail in non-operative management are hemodynamically unstable and unresponsive to resuscitative measures and are considered for operative intervention. Continuous bleeding requires blood transfusion, angioembolization, and persistent urine extravasation requires surgical intervention. The main role of surgical intervention is to control the bleeding and solve kidney problems.
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Angiographic Embolization - Angioembolization is a minimally invasive technique used to include the arteries to prevent bleeding. Embolic agents such as coils, plugs, and particles, either permanent or temporary, are loaded into a catheter and injected into the target artery. Selective angiography with angioembolization is beneficial in preventing renal loss and preserving renal function. It is safe and effective in controlling bleeding from penetrating injuries. It is an efficient method when surgery fails to control bleeding. It is an ideal technique to control late vascular complications when reoperation is not possible.
Conclusion :
Trauma to the kidneys is high in patients with blunt or penetrating injuries to the chest, pelvis, and abdomen. So it is essential to be aware during the history recording of the patient. Morbidity and mortality of renal trauma depend on concomitant injuries, management of the damage, and greed of the injury. Although the presence causes morbidity, renal function loss can be declined by the standard of care approach in non-operative management.
The modern techniques of super-selective renal artery angioembolization have declined the rate of complete renal failure. The selective embolization of the blood bleeding vessels is done in the affected portion of the kidney. The traditional technique of main artery embolization or nephrectomy resulted in a complete loss of kidney function.
