First, the accumulative knowledge about the safety and outcome of the renal trauma nonoperative approach, 1 17 and also for the management of other internal organs like the spleen and liver. Component separation in abdominal trauma journal of. Oct 15, 2015 this study aimed to appraise the role of interventional radiology in children with blunt renal trauma. Mesh headings used in the search included kidney, injuries, renal trauma, renorrhaphy, renovascular hypertension, nephrectomy, page kidney. The prevalence of renal trauma among trauma patients ranges from 0. Injuries are frequently referred to as being either blunt or penetrating injuries as these different basic mechanisms have implications for management and outcomes. Background the european association of urology eau guidelines group for urological trauma prepared these guidelines in order to assist medical professionals in the management of urological trauma. Dec 23, 2014 renal artery embolization rae is a useful adjunct to medical resuscitation in severe penetrating, iatrogenic or blunt renal traumatisms with active bleeding, and may avoid the need for surgery. Renal artery embolizationindications, technical approaches. Renal ultrasonography should be performed in most patients with acute kidney injury to rule out obstruction. The lions share of renal trauma patients are managed nonoperatively with careful monitoring, reimaging when there is any deterioration, and the use of minimally invasive procedures. Yamacake kg, lucon m, lucon am, mesquita jl, srougi m.
Jul 10, 2018 renal trauma management has evolved during the last decades, with a distinct evolution toward a nonoperative approach. The clinical data, injury severity score, days of hospital stay, outcomes and complications of pediatric renal trauma were recorded and evaluated. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. The kidney is the most commonly injured genitourinary organ with a male female ratio 3. However, the absence of hematuria does not preclude significant renal injury. Efast has low sensitivity and specificity in kidney trauma. Renal injury occurs in approximately 8%10% of blunt or penetrating abdominal trauma, and 1%5% of all traumas. We hypothesize that renal svi fare well with conservative management alone and should be relegated a less severe renal aast grade.
The purposes of this pictorial essay are to show mdct findings of renal trauma and describe the indications and protocol for mdct. Denmark, 23 january 2014, and finally accepted for. Ct scans are the gold standard for evaluating blunt and penetrating renal injuries in stable patients. The incidence of renal injuries increases in preexisting congenital or acquired renal pathology e. In this issue of the journal, kellum and colleagues pp. Eau guidelines on urological trauma european urology. Successful nonoperative management of highgrade blunt renal. Renal trauma occurs in approximately 15% of all traumas1 and 10% of all abdominal trauma2. Blunt renal trauma accounts for 7195% of renal trauma cases. Nov 22, 2016 renal dysfunction is infrequent, but complicates both the management and the outcome of trauma patients.
Urotrauma guideline american urological association. Grimsby gm, voelzke b, hotaling j, sorensen md, koyle m, jacobs ma. Pdf renal injury occurs in 1%5% of all traumas, causing disability or even death. For the majority of renal injuries, nonoperative management is the standard of care with nephrectomy reserved for those with severe trauma. Prevention of acute kidney injury through accurate fluid. Hill, lauren bakios, jayashree krishnan, krishnan venkatesan, mohan verghese. A synthesis of prevailing thought is depicted diagrammatically in figure 2 and is summarized as follows. The role of interventional radiology for pediatric blunt. A practical guide to evaluation and management article pdf available in the scientific world journal 4 suppl 1. Renal artery embolization rae is a useful adjunct to medical resuscitation in severe penetrating, iatrogenic or blunt renal traumatisms with active bleeding, and may avoid the need for. Retrospective analysis of 126 patients with blunt trauma, treated at a regional trauma center during a year period.
The kidneys are the most commonly injured genitourinary organ in children following blunt abdominal trauma. Blunt renal trauma and the predictors of failure of nonoperative management. Altogether 57 papers were found using the reported search, of which 10 presented the best evidence to answer the clinical question. Optimal fluid balance management is essential for the prevention of aki and this can be particularly challenging in the patient with trauma. Suspected renal trauma results from reported mechanism of injury and physical examination. This study in a dedicated trauma intensive care unit ticu population aimed to assess the outcomes of renal injuries and identify factors that predict the need for nephrectomy. Evaluation of renal function after major renal injury. Severe renal injuries are usually associated with multisystem injuries, may require interventional radiology to control hemorrhage and improve the chances for renal salvage, and are more likely to fail nonoperative management. A posterior sheath release was then performed to provide medial movement of the sheath, so that it could be closed in the midline see fig. Nonneoplastic pathologic findings in nephrectomy specimens. Article information, pdf download for renal trauma.
Successful nonoperative management of highgrade blunt. We excluded case reports and articles that did not include a majority. Investigating microscopic haematuria in blunt abdominal trauma. Characteristics and management of blunt renal injury in children. Angioembolization has emerged as an important modality to increase the success rate of nonoperative management of kidney injuries. Contemporary evaluation and management of renal trauma.
The american association for the surgery of trauma aast grading system was used to define the renal injury grade. Of the injuries, 74% were classified as contusions and needed only conservative. However, most renal injuries are mild in severity and successfully managed conservatively. Although the damagecontrol surgery principles are applicable to thoracic trauma, there is a dearth of data on damagecontrol thoracic surgery. We performed a retrospective study of high grade blunt renal injuries at our level i trauma center to determine the indications and success of nonoperative management nom. Though the retroperitoneal location affords the kidneys some protection from the forces experienced in blunt abdominal trauma, the kidneys are at greater risk of injury when a disease process exposes them from their normal shielded location. Clipping is a handy way to collect important slides you want to go back to later. First, the accumulative knowledge about the safety and outcome of the renal trauma nonoperative approach, 1 17 and also for the management of other internal organs like the spleen. Table of contents 2014 page 3 case reports in emergency. Journal of pediatric urology vol 10, issue 5, pages 791978. Backgrounddamagecontrol surgery is successfully used for severe abdominal trauma. Jan 01, 2019 grimsby gm, voelzke b, hotaling j, sorensen md, koyle m, jacobs ma. Trauma is a leading cause of death and disability worldwide.
Apr 23, 2016 severe renal injuries are usually associated with multisystem injuries, may require interventional radiology to control hemorrhage and improve the chances for renal salvage, and are more likely to fail nonoperative management. Dangle pp, fuller tw, gaines b, cannon gm, schneck fx, stephany ha, et al. The epidemiology of renal trauma voelzke translational. The aast classification is the most widely used system to describe renal. Renal artery pseudoaneurysm after blunt renal trauma. There were 230 patients without renal injury and 45 patients with renal injury treated without exploration of the kidney in 17 patients, with exploration and renorrhaphy in nine patients, and with partial or total nephrectomy in 19 patients. Trauma refers to injury caused by external force from a variety of mechanisms, including traffic or transportationrelated injuries, falls, assault e.
Renal trauma management has evolved during the last decades, with a distinct evolution toward a nonoperative approach. Blunt renal trauma in children with previously undiagnosed preexisting renal lesions and guidelines for effective initial management of kidney injury. Blunt trauma damage caused by impact from an object that doesnt break the skin. The first casea 48yearoldfemale passenger in a road traffic accidentwas treated with lifesaving emergency nephrectomy. This difference has been attributed to the involvement of men in highrisk activities. Grade iii injuries the difference between grade ii and grade iii is the depth of renal laceration, with grade iii corresponding to a laceration greater than 1 cm, without the collecting systems involvement.
The eau released guidelines on urological trauma including iatrogenic urological trauma and on paediatric urology with a detailed trauma section in 2014, which were updated in 2015 5,6, and on iatrogenic urological trauma in 2012 7. Incidence and management of penetrating renal trauma in patients with multiorgan injury. Renal and urogenital injuries occur in approximately 1020% of abdominal trauma in adults. Onehundredfourteen 114 patients were treated conservatively. Guideline for stress ulcer prophylaxis in the intensive. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where nonoperative management is considered. Evolving mechanisms of injury and management of pediatric blunt renal trauma 20 years of experience. In patients with renal trauma that does not involve the renal vessels, the conservative management success rate is up to 95%27. Patient selection is the preliminary step in adopting a nonoperative management strategy to renal trauma. We report our experience of the management of blunt renal trauma at our hospital between january 2007 and july 2014. Management of highgrade blunt renal trauma sciencecentral. Evolving mechanisms of injury and management of pediatric blunt renal trauma20 years of experience. Read the joint virtual issue from journal of renal care and journal of human nutrition and dietetics here.
There is a paucity of literature defining the optimal indications for renal. The journal of renal care has published a virtual issue on vascular access, edited by jennie king. Renal trauma management has evolved during the last decades, with a clear transition toward a nonoperative approach. Journal of trauma and injury volume 30, number 4, december 2017. Blunt renal trauma in children with preexisting renal. Renal trauma management has evolved during the last decades, with a distinct. Renal trauma is more commonly seen in young males, with a mean age of 30. We sought to examine the modern epidemiology of renal trauma over the past decade. The financial burden to the national health service is high and it can affect up to one in five inpatients. Methods we retrospectively identified patients with svi and g4 csl admitted to a level 1 trauma center between 2003 and 2010.
The eau urological trauma guidelines panel consists of an international group of clinicians with particular. Renal trauma in a trauma intensive care unit population. The incidence of posttraumatic acute kidney injury aki varies widely from 0. Case reports in emergency medicine table of contents 2014 case reports in emergency medicine publishes case reports and case series related to prehospital care, disaster preparedness and response, acute medical and paediatric emergencies, critical care, sports medicine, wound care, and toxicology. Longitudinal assessment of adult cases performed by graduating urology residents in the united states. Kidney renal trauma is when a kidney is injured by an outside force. Risk factors and kidney susceptibility for acute injury as well as specific exposures have been extensively studied 3, 4, whereas recovery after aki has been largely neglected. Your kidneys are guarded by your back muscles and rib cage. Genitourinary trauma, management of practice management. The diagnosis and management of renal trauma sage journals. Ct is indicated when patients have gross hematuria, hypotension, lumbar spinal injury, and fractures of lower ribs or the transverse process. The epidemiology of renal trauma pubmed central pmc. Renal trauma is less common but often occurs in polytrauma. Contemporary management of acute kidney trauma sciencedirect.
The journal gives particular emphasis to papers that integrate the findings. April 2016 contemporary evaluation and management of renal trauma a male predominance of 3. Complications following renal trauma nephrology jama. Now customize the name of a clipboard to store your clips. In general, hematuria 5 red blood cells per highpower field is present in over 95% of patients who sustain renal trauma, 1. Acute kidney injury aki is associated with increased patient morbidity, mortality and an extended hospital stay. Management of blunt renal trauma kurian george, salim al. Renal trauma patients are largely managed conservatively but on occasion have to be embolised or taken to theatre for definitive surgical management, usually in the form of emergency nephrectomy. Trauma is the leading cause of death and disability world wide. Contemporary evaluation and management of renal trauma a male predominance of 3. Jan 01, 2019 in the setting of blunt renal trauma and selected instances of penetrating renal trauma, a nonoperative approach may be selected. Of 5790 pediatric blunt trauma admissions, 68 children sustained renal trauma incidence. Lucy kornblith and colleagues from san francisco general, dr. But injuries can happen as a result of blunt trauma or penetrating trauma.
One series, with predominantly blunt mechanisms of injury, documented that 85% of patients were treated. The lions share of renal trauma patients are managed nonoperatively with careful monitoring, reimaging when there is any deterioration, and the use of. The aua guidelines on urological trauma were released in. C 17 adequate fluid balance should be maintained in patients with acute kidney injury. In general, blunt injuries are more common, accounting for up to 90%95% of renal injuries. Ct is the most informative radiologic study in renal trauma and is the examination of choice in patients suspected of having serious renal injuries or associated injuries amenable to ct evaluation. Of these, 15 adult and 5 pediatric articles met our a priori search criteria. The most common mechanism for renal injury is blunt trauma predominantly. Blunt injury accounts for 8095% of renal injury trauma in the united. Renal and urogenital injuries occur in approximately 1020% of abdominal trauma in adults and children. Steve shackford and colleagues from the western trauma association, and dr. Renal injuries account for 10% of abdominal trauma, and thus the demographic of affected individuals reflects that population. The largest percentage of such injuries occurred in the age group 1014 and were seen after falls or automobile accidents. Current management of highgrade blunt renal trauma favors a nonoperative approach when possible.
The management of solid organ injury continues to evolve from operative therapy to nonoperative therapy with the highest success rates seen in the management of blunt renal trauma. This study illustrates that nonoperative treatment of major renal lacerations with or without urinary extravasation is safe and effective in haemodynamically stable patients. Renal dysfunction is infrequent, but complicates both the management and the outcome of trauma patients. Renal function studies were performed in 275 severely injured patients with hemorrhagic shock and mastsive transfusion. The effects of treatment of renal trauma on renal function. Gor 1b contrastenhanced ct scan associated with delayed urographic phase is the gold standard in hemodynamic stable or stabilized adults after blunt of penetrating trauma and in severely injured children when kidney or urinary tract injury is suspected. It is a potent activator of the sympathetic nervous system leading to intense vasoconstriction, endothelial dysfunction, oxidative stress, platelet activation and decrease in prostaglandins e2 and prostacyclin. Angela sauaia present highlights from the february 2014 issue of the journal of trauma. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where nonoperative management is considered the.
Renal trauma children are more susceptible than adults to major renal injury due to their kidney size and location less perirenal fat weaker abdominal musculature less wellossified thoracic cage kidneys with congenital abnormalities are at increased risk. Renal trauma can result from direct, blunt, penetrating and iatrogenic injury. All documents can be viewed free access through the eau website. We present an overview of renal trauma as illustrated by three interesting cases of blunt renal trauma who presented in quick succession of each other to the emergency department. Cocaine is abused worldwide as a recreational drug. Article pdf available in international journal of current advanced research 7 7a. Fig c algorithm for managing grade i to iv renal trauma.
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