Kidney
MECHANISMS
■ Renal contusions (92%)
■ Renal lacerations (5%)
■ Minor: Cortical
■ Major: Involves medulla and/or collecting system
■ Pedicle injury (2%): Injuries to the renal vasculature, may result in renal
artery thrombosis and loss of kidney
■ Renal ruptures (1%): Expanding perirenal hematoma
DIAGNOSIS
■ CT with IV contrast
■ Retrograde pyelogram specifically for renal pelvis
■ Angiogram or venogram used for suspected renal pedicle injuries, such as
when a contrast CT or IVP demonstrates no contrast in the kidney
TREATMENT
■ Isolated contusions, minor lacerations < 1 cm, and nonexpanding hematomas
may be sent home.
■ Absolute indication for surgery is renal injury with retroperitoneal bleed-
ing and hemodynamic instability.
■ Surgery is also indicated for the following:
■ Uncontrolled renal hemorrhage
■ Most penetrating injuries
■ Multiple kidney lacerations
■ Ruptured kidney
■ Avulsed major renal vessel or vascular injury: In patients with pedicle
injuries, surgical intervention should occur within 12 hours to prevent
kidney loss.
■ Extensive extravasation of contrast on imaging
■ Most patients with kidney injuries who do not need surgery should be
admitted for observation.
COMPLICATIONS
Renovascular hypertension (1%)
Ureter
Ureteral injury is usually due to penetrating trauma.
SYMPTOMS/EXAM
■ Hematuria (rarely present with complete tears)
■ Flank pain and mass
DIAGNOSIS
■ CT with IV contrast
■ Retrograde pyelogram
TREATMENT
Repair or stenting
TRAUMAConsiderable blunt force is
necessary to damage the
kidneys because they are so
well protected.All ureteral injuries require
intervention either surgical
or IR.