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

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Injury of kidney (C0160420)

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, ジンソンショウNOS, ジンソンショウ, ジンゾウソンショウ
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, ジンシュッケツ
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