II. Causes
- Blunt Trauma to the flank or left upper quadrant Abdomen
- High velocity impact injury
- Penetrating Abdominal Trauma
III. Risk Factors
- Children are higher risk from Kidney injury in Blunt Abdominal Trauma
IV. Symptoms
V. Signs
- Hypotension
- Ecchymosis at flank
- Costovertebral Angle Tenderness (CVA Tenderness or flank tenderness)
VI. Labs
- Comprehensive metabolic panel
- Complete Blood Count
- Urinalysis with microscopic exam
VII. Imaging
-
CT Abdomen and Pelvis with IV Contrast
- Preferred first line study
- Intravenous pyelogram
- Rarely used in U.S., but consider if CT not available
- May demonstrate non-functioning Kidney or significant extravasation
- Consider angiography in Grade 3 Injury or greater
VIII. Grading
- Grade 1 Renal Injury
- Contusion or subcapsular Hematoma and
- No parenchymal Laceration
- Grade 2 Renal Injury
- Non-expanding perirenal Hematoma or
- Renal or cortical Laceration <1 cm without urinary extravasation
- Grade 3 Renal Injury
- Parenchymal Laceration depth >1 cm into renal cortex AND
- No rupture or urinary extravasation
- Grade 4 Renal Injury
- Major parenchymal HemorrhageLacerations through cortical Medullary junction, into collecting system
- Renal artery and vein injury with contained Hemorrhage
- Grade 5 Renal Injury
- Kindey shattered with multiple Lacerations
- Renal pedicle injury
IX. Management: General
- Grade 2 Renal Injury
- Observation with bedrest
- Follow with serial Ultrasound
- Grade 3 Renal Injury
- Observation in most cases
- Surgical management in severe cases
- Grade 5 Renal Injury
- Manage Hemorrhagic Shock
- Emergent surgery
X. Management: Return to Play in Athletes
- Grade 1 Renal Injury (most common sports related Renal Injury)
- May return after 6 weeks of no Contact Sports IF no Hematuria
- Grade 2 Renal Injury
- Initial hospital observation
- No sporting activity until Hematuria clears
XI. References
- Dreis (2020) Crit Dec Emerg Med 34(7):3-21