Hematuria Renal Injuries |
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Incidence | Illustration |
In blunt abdominal trauma the kidney is the most frequently involved organ in childhood because of its relatively large size, and because it is more mobile, more exposed, and less protected by comparison. | show details |
Clinical significance | |
1. Depending on the degree of trauma, the loss of the whole organ or of parts of it is possible. | |
Etiology | |
The etiology depends on the age. Falls in toddlers, motor vehicle trauma and sports injuries in schoolchildren. | |
Pathology, anatomical types | Illustrations |
Mostly blunt traumas. There are different grades of renal injuries: | show details |
Pathophysiology | |
The biomechanics of the blunt abdominal trauma. | |
Clinical presentation (history, findings, clinical skills) | Illustrations |
- Pain in the flank and abdomen. | show details |
Natural history | |
Lower grades of renal injuries recover without surgery and without major sequels. In severe grades the development of pseudocysts, caliceal diverticula (for instance an upper calix syndrome), and renal hypertension are possible; the former if no drainage of urinoma, reconstruction of pelvis and/or resection of major destroyed parts of the renal parenchyma is performed. | |
Differential diagnosis | Illustrations |
The differential diagnosis mainly includes causes of: | show details |
Work-up examinations | Illustrations |
Work-up examinations depend on the degree of abdominal trauma. In general, blood and urine analysis, Doppler ultrasound (Doppler to exclude a renal artery thrombosis) and IVU for the evaluation of the pelvis and ureter. In severe trauma, immediate CT with contrast instead of the former imaging examinations, which allows to discover combined intraabdominal injuries and to assess the grade and precise anatomy of the renal trauma. | show details |
Therapy | Illustrations |
In grade I and II injuries, non-operative management, and in grade IV and V, surgery is indicated. In grade III, the appropriate treatment depends on the precise pattern of kidney injury and on other factors, e.g. polytrauma or pre-existing pathology of the involved kidney. In urinoma, at least antibiotics are indicated. Hospitalization in case of severe kidney injury or polytrauma, and longterm follow-ups in operated patients and in those with border-line non-operative treatment. | show details |
Prognosis | Illustrations |
Favourable prognosis except for grade V trauma with imminent loss of kidney and hemorrhagic shock; a thrombosis of the renal artery, which is typical for children and which is due to an endothelial damage, mostly leads to a loss of the kidney, even after immediate intervention.
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