Kidney trauma is an injury to the kidneys. Such trauma can be triggered, for example, by blunt force. Many kidney traumas result from accidents during sports or traffic accidents.
What is kidney trauma?
A trauma in medicine is a term for an injury to organ tissue. This wound is caused by external violence. Consequently, in the case of kidney trauma, the kidneys are affected by such an injury caused by an external force. See etaizhou for What does Myopia Mean.
Kidney trauma usually does not occur in isolation, but in connection with other injuries. Depending on the origin, a distinction can be made between open and closed kidney injuries. Classifications also exist to classify the extent of the injuries.
Causes
The main causes of closed kidney trauma include traffic accidents and accidents during sports. Open kidney trauma is caused by stab wounds or gunshot wounds. The injuries not only damage the affected persons directly through the damage to the kidney tissue, but also indirectly have a negative impact on the entire organism. Thus, indirect effects such as blood loss can cause damage.
In most cases, kidney trauma occurs along with other injuries. The kidneys are involved in up to 40 percent of all cases of blunt abdominal trauma. 80 percent of all kidney injuries are polytraumas. Open kidney injuries are rare in Europe. In the USA, on the other hand, they play a larger role. Kidney trauma from gunshot wounds dominates here.
Symptoms, Ailments & Signs
Depending on the severity, kidney trauma can be divided into a kidney contusion, a kidney rupture and an organ rupture or kidney pedicle tear. Kidney contusion occurs in 70 percent of cases. Kidney rupture occurs in 20 percent of all cases, and about 10 percent of kidney trauma involves organ rupture.
In the case of a kidney contusion, the kidney is bruised or crushed. However, the kidney capsule is still intact. There is no hematoma behind the peritoneum. In the event of a rupture, the functional tissue of the kidney is torn. The organ capsule is also ruptured, allowing blood to leak into the retroperitoneal space. This forms a retroperitoneal hematoma.
In the case of more severe ruptures, the kidney’s urine filtering and drainage structures can also be affected by the injury. In such cases, urine leaks into the retroperitoneal space and there is also a functional failure of the kidneys. When an organ is ruptured, the kidney is completely torn. The function fails and severe internal bleeding occurs.
Diagnosis & course of disease
The main symptom of kidney trauma is pain in the flank area . Depending on the trauma, these can be rather light or very strong. Swelling in the flank area may be visible. One then speaks of a flank tumor. The flank can also be bluish in color due to a hematoma. Additionally, blood may be visible in the urine (macrohematuria). The amount of blood found in the urine cannot be used to determine the extent of the injury.
If the ureter is displaced by a blood clot or is even torn off, there may be no blood at all in the urine, despite the severity of the injury. The injury leads to defensive tension in the abdomen and possibly also to a palpable mass. Depending on how much blood is lost, those affected may go into shock.
Complications
In the worst case, a kidney trauma can lead to complete kidney failure and thus to the death of the person concerned. In this case, the patient is dependent on permanent dialysis or a kidney transplant. If there is no treatment, the kidney trauma usually leads to the death of the person concerned.
Kidney trauma sufferers also experience very severe pain, which usually continues to spread to the back or other parts of the body. Internal bleeding and hematomas can also occur and continue to significantly reduce the quality of life of those affected. If it is a slight kidney trauma, the function of the kidney may be impaired.
In many cases, the area around the kidneys is significantly swollen and flank pain occurs. This usually turns the urine red. There are no special complications from the treatment. In severe cases, a kidney transplant can save the patient’s life. However, the patient’s life expectancy may still be reduced as a result of the kidney trauma.
When should you go to the doctor?
If kidney trauma is suspected, a doctor must be consulted immediately. If severe pain in the kidneys is noticed after a blow to the kidneys or after an accident or fall, this indicates such a trauma. If there is swelling or bleeding, there may be a higher degree of kidney trauma, which must also be treated immediately. Affected people should call an ambulance or go to a hospital. There, the kidney injury can be diagnosed and treated immediately.
People who are no longer able to move due to the kidney injury must be treated by an emergency doctor, as there may be a shattered kidney with torn renal vessels. Fifth degree renal trauma requires inpatient treatment. Close medical monitoring is also necessary afterwards so that the necessary measures can be initiated quickly in the event of any complications. In addition to the family doctor, a nephrologist or another internist can treat the kidney trauma. Severe trauma may require surgical intervention.
Kidney trauma with subsequent kidney failure is a serious medical emergency that must be treated in a hospital in any case. The patient needs rest and rest for a few months, combined with regular visits to the doctor and extensive physiotherapy. If an accident preceded the kidney trauma, trauma therapy may also be necessary.
Treatment & Therapy
The symptoms present and the presence of a traumatic event provide the first indications of a kidney trauma. First, a thorough physical examination is performed. The abdomen is palpated and the kidney area is also palpated with extreme caution. Hematomas or swellings may already be visible during the inspection. An ultrasound scan will show possible bruising and kidney tissue damage.
The exact morphology of the injury thus becomes visible. If there is a kidney rupture, a computed tomography is also performed. This is the only way to determine the extent of the rupture. Possible leakage of urine (extravasation), blood flow from kidney fragments and accompanying injuries to the spleen and liver become visible. The condition of the opposing kidney can also be better assessed in this way. If a CT scan is not available, the kidney should be visualized with contrast media.
Outlook & Forecast
The prognosis of kidney trauma depends on the type and extent of the damage. The best prospects for full recovery are those with mild to moderate renal lesions that are treated without complications. In the case of severe damage to kidney tissue or blood vessels, it is often not possible to preserve the kidney: If only one kidney is affected, the remaining kidney usually takes over its function without any significant restrictions.
The prognosis worsens if complications such as bleeding or bruising occur immediately after the operation. Especially in the case of multiple injuries to the organ, the penetration of bacteria can lead to life-threatening blood poisoning (sepsis). Appropriate therapy with antibiotics minimizes this risk considerably.
According to Rassweiler, the long-term consequence of kidney trauma is a loss of function in ten percent of all cases. Renal hypertension develops in one to five percent of those affected, and one percent develops a contracted kidney. Two percent of patients subsequently suffer from kidney stones (nephrolithiasis), and one to eight percent complain of recurring urinary tract infections.
Regular and careful follow-up examinations such as urine examinations, ultrasound examinations and blood pressure checks can help to identify consequential damage at an early stage and to treat it accordingly at an early stage.
Prevention
Therapy for kidney trauma depends on the type of injury and the degree of injury. It is important for the choice of therapy whether the injury is open or closed. Possible accompanying injuries and the general condition as well as the circulatory situation of the patient also play a role.
Open stab and gunshot wounds are always treated surgically. This is the only way to ensure that other organs are not affected. Kidney contusion is usually treated conservatively with painkillers. In addition, those affected must remain calm and avoid further trauma. The best treatment for a kidney rupture is controversial.
Conservative treatment is possible provided there is no renal pedicle tear. However, a CT must be created to determine the extent. After three to six days, a second CT is made. If there is no improvement, surgery is required. The kidney may have to be partially or completely removed. Intervention must also be carried out in the event of a permanently destabilized circulatory system or if there is a risk of bacterial blood poisoning.
In many cases, however, kidney trauma can also be controlled with minimally invasive treatment methods, so that many patients are spared a (partial) removal of the kidney. Kidney trauma is difficult to prevent. For motorcyclists, a kidney belt can possibly protect against injuries in the event of an accident. Back protectors also offer protection.
Aftercare
In most cases, conservative aftercare is sufficient. In addition to strict bed rest, the prophylactic administration of an antibiotic counts here. Bed rest should be maintained until a significant reduction in the hematoma can be observed. The antibiotic is intended to counteract infection of the hematoma or urinoma.
In addition, a precise check of pulse, blood pressure, temperature, blood count and retention values is recommended. This is then followed by a check by ultrasound and computed tomography. Depending on the clinical picture, the ultrasound examination should be carried out every one to three days. After two weeks, after four weeks and after three months, the data is recorded using the computer tomograph.
In many cases it makes sense to have the kidney function determined by means of scintigraphy. The kidneys can be explicitly examined with the help of an intravenous administration of radioactive substances. The focus here is on the time course from absorption to excretion of the radiating substance.
After the hospital stay, all the follow-up examinations described above to monitor the healing process can be carried out by a urologist. It should be noted that external application of heat is counterproductive. In addition to saunas, this also includes hot showers or baths.
You can do that yourself
If kidney trauma is suspected, a doctor should first be consulted. In any case, the condition requires specialist treatment in the hospital, because otherwise it can lead to serious complications and, in the worst case, even to the death of the patient.
Kidney trauma is usually treated surgically. Bed rest and rest apply after the operation. If necessary, the diet must also be changed so that the kidneys are not exposed to any further stress. Affected people should also not do any sport until the injury has completely healed. In consultation with a sports doctor or physiotherapist, light exercises from the field of physiotherapy may be carried out.
Severe kidney trauma can result in permanent impairments, which often also weigh on those affected emotionally. It is advisable to seek dialogue with other people affected and to take additional measures to overcome the psychological trauma. Since kidney trauma is always a serious injury, further self-help measures should be avoided. In individual cases, the therapy can be supported by natural painkillers from the field of naturopathy.
