II. Causes
- Blunt Trauma to the flank or left upper quadrant Abdomen
- High velocity impact injury
- Penetrating Abdominal Trauma
III. Risk Factors
- Children are higher risk from Kidney injury in Blunt Abdominal Trauma
IV. Symptoms
V. Signs
- Hypotension
- Ecchymosis at flank
- Costovertebral Angle Tenderness (CVA Tenderness or flank tenderness)
VI. Labs
- Comprehensive metabolic panel
- Complete Blood Count
- Urinalysis with microscopic exam
VII. Imaging
-
CT Abdomen and Pelvis with IV Contrast
- Preferred first line study
- Intravenous pyelogram
- Rarely used in U.S., but consider if CT not available
- May demonstrate non-functioning Kidney or significant extravasation
- Consider angiography in Grade 3 Injury or greater
VIII. Grading
- Grade 1 Renal Injury
- Contusion or subcapsular Hematoma and
- No parenchymal Laceration
- Grade 2 Renal Injury
- Non-expanding perirenal Hematoma or
- Renal or cortical Laceration <1 cm without urinary extravasation
- Grade 3 Renal Injury
- Parenchymal Laceration depth >1 cm into renal cortex AND
- No rupture or urinary extravasation
- Grade 4 Renal Injury
- Major parenchymal HemorrhageLacerations through cortical Medullary junction, into collecting system
- Renal artery and vein injury with contained Hemorrhage
- Grade 5 Renal Injury
- Kindey shattered with multiple Lacerations
- Renal pedicle injury
IX. Management: General
- Grade 2 Renal Injury
- Observation with bedrest
- Follow with serial Ultrasound
- Grade 3 Renal Injury
- Observation in most cases
- Surgical management in severe cases
- Grade 5 Renal Injury
- Manage Hemorrhagic Shock
- Emergent surgery
X. Management: Return to Play in Athletes
- Grade 1 Renal Injury (most common sports related Renal Injury)
- May return after 6 weeks of no Contact Sports IF no Hematuria
- Grade 2 Renal Injury
- Initial hospital observation
- No sporting activity until Hematuria clears
XI. References
- Dreis (2020) Crit Dec Emerg Med 34(7):3-21
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Injury or Poisoning (T037) |
| ICD9 | 866 |
| ICD10 | S37.0 , S37.00 |
| SnomedCT | 157343006, 269158000, 210209001, 40095003 |
| English | Injury to kidney NOS, kidney injury (diagnosis), kidney injury, Renal injury NOS, Unspecified injury of kidney, Injury of kidney, unspecified, renal injury, injuries renal, injuries kidneys, injury renal, injury to kidney, injuries kidney, injury kidney, Injury to kidney NOS (disorder), Injury to kidney, Injury of kidney, Renal injury, Injury of kidney (disorder), injury; kidney, kidney; injury, Injury of kidney, NOS, Renal injury, NOS, Injury to Kidney |
| Italian | Traumatismo renale, Traumatismo renale NAS, Traumatismo del rene |
| Dutch | nierletsel NAO, letsel aan nier, letsel; nier, nier; letsel, Letsel van nier, nierletsel |
| French | Lésion du rein SAI, Lésion du rein |
| German | Verletzung der Niere, Nierenverletzung NNB, Nierenschaedigung |
| Portuguese | Lesão traumática do rim, Lesão renal traumática NE, Lesão renal |
| Spanish | Lesión traumática del riñón NEOM, Lesión traumática de riñón, lesión de riñón, SAI, lesión renal, SAI, lesión renal, SAI (trastorno), injuria renal, lesión traumática del riñón (trastorno), lesión traumática del riñón, traumatismo renal, Lesión traumática del riñón |
| Japanese | 腎臓損傷, 腎損傷, 腎損傷ＮＯＳ, ｼﾞﾝｿﾝｼｮｳNOS, ｼﾞﾝｿﾝｼｮｳ, ｼﾞﾝｿﾞｳｿﾝｼｮｳ |
| Czech | Renální poranění NOS, Poranění ledviny |
| Korean | 콩팥(신장)의 손상 |
| Hungarian | Vesesérülés, Vesesérülés k.m.n. |
Ontology: Laceration of kidney (C0347649)
| Concepts | Injury or Poisoning (T037) |
| ICD10 | S37.02 |
| SnomedCT | 262893009 |
| English | laceration of kidney (diagnosis), laceration of kidney, kidney laceration, kidney lacerations, Laceration of kidney, Laceration of kidney (disorder) |
| Spanish | laceración de riñón (trastorno), laceración de riñón |
Ontology: Hemorrhage of kidney (C0392175)
| Definition (NCI) | Bleeding originating from the kidney. |
| Definition (NCI_CTCAE) | A disorder characterized by bleeding from the kidney. |
| Concepts | Disease or Syndrome (T047) |
| SnomedCT | 95571006 |
| Italian | Emorragia renale, Sanguinamento renale |
| Dutch | bloeding nier, hemorragie nier, bloeding; nier, nier; bloeding, nierbloeding |
| French | Hémorragie du rein, Saignement rénal, Hémorragie rénale |
| German | Blutung der Niere, Bluten einer Niere, Nierenblutung |
| Spanish | Hemorragia de riñón, Sangrado renal, hemorragia del riñón (trastorno), hemorragia del riñón, hemorragia renal, Hemorragia renal |
| Japanese | 腎出血, ｼﾞﾝｼｭｯｹﾂ |
| English | Hemorrhage of kidney, Hemorrhage kidney, Renal Hemorrhage, kidney hemorrhage, Renal bleeding, Haemorrhage kidney, Haemorrhage of kidney, Renal haemorrhage, Renal hemorrhage, Hemorrhage of kidney (disorder), hemorrhage; kidney, kidney; hemorrhage |
| Czech | Renální krvácení, Krvácení ledviny |
| Hungarian | Vesevérzés, Renalis haemorrhagia |
| Portuguese | Sangramento renal, Hemorragia renal |
Ontology: Contusion and hematoma of kidney (C0840561)
| Concepts | Injury or Poisoning (T037) |
| ICD10 | S37.01 |
| English | Contusion and haematoma of kidney, Contusion and hematoma of kidney |
