Fact-sheet: Trauma to kidney


Updated on 08/26/2020 at 2:01 PM

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Definition

Renal traumatic injuries are often due to blunt trauma. (Direct impact is the most common mechanism, with crushing of the kidney against the muscles and skeleton)

Indirect impact is rarer and results in pedicle avulsion by traction.

Renal contusions account for 10% of all visceral trauma.

Clinical features

  • Macroscopic/microscopic hematuria
  • Signs of shock

Laboratory findings

  • Acute renal failure

CT

Contrast-enhanced CT with delayed images (5 to 7 minutes)

  • Subcapsular Hematomas
  • Perirenal/pararenal Hematomas
  • Contusions, lacerations, fractures
  • Urohematoma (contrast extravasation on delayed images)
  • Absence of renal enhancement, consequent to vascular injury

Vascular intervention

  • Selective embolization in cases of active bleeding

Management

  • Conservative management
  • Nonoperative management for Chatelain grade I and II
  • Surgery in cases of renal pedicle avulsion
  • Endoscopic urinary diversion in cases of Urinoma (ureteral catheter or JJ stent)

Classification

AAST classification

  • Renal contusion, subcapsular Hematoma without fracture and without perirenal Hematoma
  • Superficial fracture (<1 cm) with nonexpanding perirenal Hematoma
  • Deep fracture (>1 cm) without collecting system involvement
  • Deep fracture with collecting system involvement (urinary extravasation);
    pedicle arterial thrombosis due to dissection;
    vascular pedicle injury with infarction or contained Hematoma
  • Shattered or multifractured Kidney,
    renal pedicle injury, ureteropelvic avulsion

Chatelain classification:

  • Benign lesions, intact renal capsule
  • Ruptured renal capsule
  • Complex fracture with parenchymal tearing or shattering associated with collecting system disruption
  • Renal pedicle injuries