II. Causes

  1. Blunt Trauma to the flank or left upper quadrant Abdomen
  2. High velocity impact injury
  3. Penetrating Abdominal Trauma

III. Risk Factors

  1. Children are higher risk from Kidney injury in Blunt Abdominal Trauma

V. Signs

VI. Labs

  1. Comprehensive metabolic panel
  2. Complete Blood Count
  3. Urinalysis with microscopic exam

VII. Imaging

  1. CT Abdomen and Pelvis with IV Contrast
    1. Preferred first line study
  2. Intravenous pyelogram
    1. Rarely used in U.S., but consider if CT not available
    2. May demonstrate non-functioning Kidney or significant extravasation
      1. Consider angiography in Grade 3 Injury or greater

VIII. Grading

  1. Grade 1 Renal Injury
    1. Contusion or subcapsular Hematoma and
    2. No parenchymal Laceration
  2. Grade 2 Renal Injury
    1. Non-expanding perirenal Hematoma or
    2. Renal or cortical Laceration <1 cm without urinary extravasation
  3. Grade 3 Renal Injury
    1. Parenchymal Laceration depth >1 cm into renal cortex AND
    2. No rupture or urinary extravasation
  4. Grade 4 Renal Injury
    1. Major parenchymal HemorrhageLacerations through cortical Medullary junction, into collecting system
    2. Renal artery and vein injury with contained Hemorrhage
  5. Grade 5 Renal Injury
    1. Kindey shattered with multiple Lacerations
    2. Renal pedicle injury

IX. Management: General

  1. Grade 2 Renal Injury
    1. Observation with bedrest
    2. Follow with serial Ultrasound
  2. Grade 3 Renal Injury
    1. Observation in most cases
    2. Surgical management in severe cases
  3. Grade 5 Renal Injury
    1. Manage Hemorrhagic Shock
    2. Emergent surgery

X. Management: Return to Play in Athletes

  1. Grade 1 Renal Injury (most common sports related Renal Injury)
    1. May return after 6 weeks of no Contact Sports IF no Hematuria
  2. Grade 2 Renal Injury
    1. Initial hospital observation
    2. No sporting activity until Hematuria clears

XI. References

  1. Dreis (2020) Crit Dec Emerg Med 34(7):3-21

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