Renal Trauma - Causes, Symptoms, Diagnosis, and Treatment

What Is Kidney Trauma or Renal Trauma?

Kidney or renal trauma occurs when an external force injures the kidneys. Kidney trauma causes bleeding, injures the collecting system, and causes urine leakage. The kidneys are well protected by the muscles of the back and the rib cage, but injuries can occur due to blunt trauma or penetrating trauma. Blunt trauma occurs due to an object that does not break the skin. On the contrary, penetrating trauma occurs when the object penetrates the skin and enters the body. Kidneys should be saved from traumatic injuries because they can stop working if severely injured. Therefore, the patient needs to learn about the different kidney injuries and save them from getting damaged.

What Is the Prevalence of Kidney Trauma?

Kidneys are the most integral organs of the urogenital tract because they are the ones that filter the body’s waste and toxins and form urine. Studies report that genitourinary injuries account for ten percent of all injuries, and kidneys are the most commonly affected organs. Kidney trauma or injury accounts for about one to five percent of all trauma patients, and most injuries are due to blunt trauma. In contrast, penetrating renal trauma accounts for 20 percent of all traumatic injuries. It has also been noted that people involved in sports activities are more likely to encounter kidney injuries. People below 30 years are more likely to have kidney injuries due to car accidents and other road traffic accidents. However, the patients need not be worried because the evolution of medical science has allowed the non-surgical management of kidney diseases. However, patients who have bleeding after kidney injuries must remain careful because it is a life-threatening condition and requires emergency medical care and attention.

What Happens Under Normal Circumstances?

The urinary system works as the body's drainage system because it eliminates all the toxins and waste products from the body. The urinary system includes a pair of kidneys, ureters, one urinary bladder, and a urethra. If the kidneys are healthy, they filter 120 to 150 quarts of blood daily. Normally, the kidneys are present beneath the rib cage on either side of the spine. The kidneys form one to two quarts of urine and remove extra waste and water from the blood. This urine travels from the kidneys to the urinary bladder through the ureters. Therefore, kidneys work as filtration units to maintain the following:

• Fluid levels.

• Electrolyte balance.

• Removal of waste as urine.

• Regulation of blood pressure and red blood cell count.

What Are the Causes of Kidney Injury or Trauma?

Kidney trauma can result from kidney injury alone or in combination with other urologic injuries. The causes of kidney injuries could be blunt or penetrating:

1. Blunt Trauma - It includes the following:

   1. Children are vulnerable to kidney injury in car accidents.

   2. Fall.

   3. Getting hit by any heavy object near the ribs and hips.

2. Penetrating Trauma - It includes the following:

   1. Bullet.

   2. Knife.

   3. Any object piercing the body.

What Are the Signs and Symptoms of Kidney Trauma?

Kidney trauma or kidney injury is a matter of concern and must be treated according to the severity. Hematuria, or blood in the urine, is the most common symptom of kidney trauma or kidney injury. The other symptoms include:

• Tenderness.

• Pain.

• Palpable mass in the flank or the sides.

• Abdominal or back pain.

How Is Kidney Trauma Diagnosed?

Whenever a kidney injury or a kidney trauma is suspected, laboratory and imaging tests must be done simultaneously to confirm the causes of kidney injuries. The diagnostic methods are listed below:

1. Medical History - The doctor should obtain a thorough history of the patient before suggesting any diagnostic tests. Medical history provides an idea about injury symptoms and other associated problems.

2. Physical Examination - The doctor might examine the patient physically and check for signs of kidney injury, including swelling, abdominal pain, and a palpable mass in the flank.

3. Complete Blood Count - It is a simple investigation in which blood is drawn from the patient’s arm and tested in the laboratory. It helps check the general health of the patient and the working of the kidneys. If creatinine, urea, and other waste products are in excess in the blood, the doctor can suspect that the kidneys have been damaged due to injury.

4. Urinalysis - Urinalysis is a urine testing procedure in which a urine sample obtained from the patient is evaluated in the laboratory for stones, bacteria, white blood cells, and other urologic abnormalities.

5. Computed Tomography (CT) Scan - CT scan is done to diagnose kidney injury. Mainly, a contrast-induced CT scan is done in patients with kidney injury because the injuries become visible when the contrast material flows through the body.

6. Ultrasound - Ultrasound is one of the most effective methods to diagnose kidney injuries because it does not emit X-rays and can be safely conducted in children and pregnant females. It uses sound waves that bounce off the structures present internally. As a result, the images of the urologic organs are obtained on the computer screen.

How Is Kidney Trauma Treated?

The management of kidney trauma or kidney injury depends upon the condition of the severity, its severity, and the other injuries. If the patient has no associated symptoms and is in a stable condition, the injury can be treated without surgical intervention. The patient needs to rest in the hospital until no blood is seen in urine. The patient will be constantly monitored for bleeding and associated symptoms. After the patient is discharged from the hospital, they will be observed for the signs and symptoms of kidney damage, including high blood pressure or late bleeding. However, the patient might need surgery if unstable or has lost a considerable amount of blood. Surgery aims to repair and restore the kidney’s functions. Sometimes, the kidneys are damaged so severely that they must be removed through open surgery, which does not cause a problem because the patient can easily survive on one kidney.

What Happens After the Treatment?

People who have undergone kidney injury or trauma treatments suffer from problems like delayed bleeding or urinary incontinence (leakage of urine). However, these problems can be treated using endoscopy or angiographic embolization. If these procedures fail to produce the desired results, surgery is required, and the kidneys need to be removed. Other problems the patients encounter are the formation of pus pockets or abscesses around the kidneys. It can be treated by placing the tube and draining the pus from the abscess. People suffering from high blood pressure after kidney injury can be treated with antihypertensives.

Conclusion:

Renal injury or kidney trauma is a common cause of urologic problems and kidney failure. People suffering from kidney trauma also encounter problems related to urination because the kidneys are the primary organs responsible for urine production. However, the patient must not be worried because they can easily survive if one of the kidneys is functional. Consult a urologist to know more about kidney injuries and their management.