Trauma: Kidney Trauma

Kidney Trauma

General

  • Most Common from Blunt Trauma (80-90%)
  • Maximum Warm Ischemia Time if Clamping: 20-30 Minutes

AAST Kidney Injury Scale (2018 Revision) Mn

Shattered Kidney 1

Grade I 2

Grade II 2

Grade III 2

Grade IV 3

Grade V (UPJ Avulsion) 2

Initial Management

  • Unstable: Laparotomy
    • Consider IV Pyelogram/Urogram (IVP/IVU)
  • Stable: CT

Treatment

  • Conservative Management:
    • Strict Bed Rest Until Urine Visibly Clears
    • Frequent Hgb
    • Repeat CT After 2-3 Days
  • Parenchymal Injury:
    • Superficial Laceration: Primary Repair
    • Deep Injuries: Debridement vs. Partial Nephrectomy
    • Nephrectomy May Be Required if Uncontrolled Hemorrhage from High-Grade Injury
  • Urinary Collecting System Injury:
    • Urinary Leak/Extravasation: Conservative Management
      • Stent or Nephrostomy if Fails
    • UPJ Avulsion: Surgical Repair
    • Leave Perinephric Drains If Collecting System Injured
  • Vascular Injury:
    • Active Bleeding (Stable Out of OR): Angioembolization
    • Active Bleeding (At Laparotomy): Primary Repair (Patch or Interposition if Narrows)
      • OK to Ligate Segmental Branches if Necessary
        • Results in Distal Ischemia, But Preferred Over Nephrectomy
    • Renal Artery Occlusion/Devascularization
      • Unilateral (Two Normal Kidneys) – Conservative vs Endovascular Management
      • Unilateral (Solitary Kidney) or Bilateral – Surgical Revascularization

Mnemonics

Urinary Injury Grading

  • Urinate on the FLOOR (Grade 4)

References

  1. Dantanarayana N, Ting F, Symons J, Evans D, Graham A. Isolated Grade 5 Renal Trauma in a Hemodynamically Stable Patient. Urol Case Rep. 2015 Dec 10;4:30-2. (License: CC BY-NC-ND-4.0)
  2. Szmigielski W, Kumar R, Al Hilli S, Ismail M. Renal trauma imaging: Diagnosis and management. A pictorial review. Pol J Radiol. 2013 Oct;78(4):27-35. (License: CC BY-NC-ND4.0)
  3. Mohamad Al-Ali B, Thimary F, Pummer K. Grade IV renal trauma in a 17-year-old patient. Cent European J Urol. 2013;66(2):233-5. (License: CC BY-NC-ND-3.0)