The kidney is injured in approximately 10 percent of all significant blunt abdominal trauma. Of those, 13 percent are sports-related when the kidney, followed by testicle, is most frequently involved. However, the most frequent cause by far is traffic collisions, followed by falls. The consequences are usually less severe than injuries involving other internal organs.
Blunt injuries to the kidney from helmets, shoulder pads, and knees are described in football, [1] and in soccer, martial arts, [2] and all-terrain vehicle crashes. A literature review of peer-reviewed articles in May 2009 demonstrated that urogenital injuries are uncommon in team and individual sports, and that most of them are low-grade injuries, cycling being the most commonly associated, followed by winter sports, horse riding and contact/collision sports. [3] A special situation has existed in the athletic participant with a single kidney.
Formerly, the American Academy of Pediatrics Committee on Sports Medicine and Fitness advised against such children and adolescents from participating in contact sports. Children's kidney's are prone to injury from blunt force trauma due to their size and location in a child's body. [4] However, a study of 45,000 children with kidney injuries demonstrated no kidney loss in any contact sport. Sledding, skiing and rollerblading did, however, result in such loss. [5] Further, data from the National Athletic Trainers' Association High School Injury Surveillance Study, an observational cohort study during the 1995–1997 academic years, have been used to compare incidence rates for sport-specific injuries to specific organs. There were over 4.4 million athlete-exposures, defined as 1 athlete participating in 1 game or practice. Student athletes incurred kidney injuries most often playing football (12 injuries) or girls' soccer (2 injuries). [6]
The American Academy of Pediatrics currently recommends a "qualified yes" [7] for participation by athletes with single kidneys in contact/collision sports although some physicians remain reluctant to acquiesce.
In blunt injury, imaging is indicated if there is gross hematuria, or if the patient exhibits shock together with either gross or microscopic hematuria.
The imaging modality of choice is contrast-enhanced, computed tomography (CT) which is readily available in most emergency departments of moderate or above size. Scan times have become shorter with each generation of scanners and current scans are quick and accurately demonstrate renal injuries together with associated injuries to other abdominal or retroperitoneal organs.
Unlike ultrasound examination (FAST), CT provides anatomic and functional information that allows for accurate grading of the injury which is partly responsible for a growing trend toward conservative management (intravenous fluids, close monitoring, watchful waiting) of renal trauma. [8] Conservative management does not apply in situations where extensive urinary extravasation or devitalized areas of renal parenchyma are found and especially if associated with injuries to other abdominal organs; these cases are complication-prone and much more likely to require surgery. That being said, a retrospective study suggests that primary conservative treatment of blunt kidney rupture seems to lead to less surgery, especially less open surgery, and less blood and renal parenchyma loss, compared to a strategy of initial surgery. [9]
An injury is any physiological damage to living tissue caused by immediate physical stress. An injury can occur intentionally or unintentionally and may be caused by blunt trauma, penetrating trauma, burning, toxic exposure, asphyxiation, or overexertion. Injuries can occur in any part of the body, and different symptoms are associated with different injuries.
Acute kidney injury (AKI), previously called acute renal failure (ARF), is a sudden decrease in kidney function that develops within 7 days, as shown by an increase in serum creatinine or a decrease in urine output, or both.
Major trauma is any injury that has the potential to cause prolonged disability or death. There are many causes of major trauma, blunt and penetrating, including falls, motor vehicle collisions, stabbing wounds, and gunshot wounds. Depending on the severity of injury, quickness of management, and transportation to an appropriate medical facility may be necessary to prevent loss of life or limb. The initial assessment is critical, and involves a physical evaluation and also may include the use of imaging tools to determine the types of injuries accurately and to formulate a course of treatment.
The renal arteries are paired arteries that supply the kidneys with blood. Each is directed across the crus of the diaphragm, so as to form nearly a right angle.
A splenic injury, which includes a ruptured spleen, is any injury to the spleen. The rupture of a normal spleen can be caused by trauma, such as a traffic collision.
Autotransplantation is the transplantation of organs, tissues, or even particular proteins from one part of the body to another in the same person.
Blunt trauma, also known as blunt force trauma or non-penetrating trauma, is physical trauma or impactful force to a body part, often occurring with road traffic collisions, direct blows, assaults, injuries during sports, and particularly in the elderly who fall. It is contrasted with penetrating trauma which occurs when an object pierces the skin and enters a tissue of the body, creating an open wound and bruise.
The nutcracker syndrome (NCS) results most commonly from the compression of the left renal vein (LRV) between the abdominal aorta (AA) and superior mesenteric artery (SMA), although other variants exist. The name derives from the fact that, in the sagittal plane and/or transverse plane, the SMA and AA appear to be a nutcracker crushing a nut.
Blunt splenic trauma occurs when a significant impact to the spleen from some outside source damages or ruptures the spleen. Treatment varies depending on severity, but often consists of embolism or splenectomy.
Traumatic aortic rupture, also called traumatic aortic disruption or transection, is a condition in which the aorta, the largest artery in the body, is torn or ruptured as a result of trauma to the body. The condition is frequently fatal due to the profuse bleeding that results from the rupture. Since the aorta branches directly from the heart to supply blood to the rest of the body, the pressure within it is very great, and blood may be pumped out of a tear in the blood vessel very rapidly. This can quickly result in shock and death. Thus traumatic aortic rupture is a common killer in automotive accidents and other traumas, with up to 18% of deaths that occur in automobile collisions being related to the injury. In fact, aortic disruption due to blunt chest trauma is the second leading cause of injury death behind traumatic brain injury.
Penetrating trauma is an open wound injury that occurs when an object pierces the skin and enters a tissue of the body, creating a deep but relatively narrow entry wound. In contrast, a blunt or non-penetrating trauma may have some deep damage, but the overlying skin is not necessarily broken and the wound is still closed to the outside environment. The penetrating object may remain in the tissues, come back out the path it entered, or pass through the full thickness of the tissues and exit from another area.
Abdominal trauma is an injury to the abdomen. Signs and symptoms include abdominal pain, tenderness, rigidity, and bruising of the external abdomen. Complications may include blood loss and infection.
Diaphragmatic rupture is a tear of the diaphragm, the muscle across the bottom of the ribcage that plays a crucial role in breathing. Most commonly, acquired diaphragmatic tears result from physical trauma. Diaphragmatic rupture can result from blunt or penetrating trauma and occurs in about 0.5% of all people with trauma.
Urologic diseases or conditions include urinary tract infections, kidney stones, bladder control problems, and prostate problems, among others. Some urologic conditions do not affect a person for that long and some are lifetime conditions. Kidney diseases are normally investigated and treated by nephrologists, while the specialty of urology deals with problems in the other organs. Gynecologists may deal with problems of incontinence in women.
Kidney tumours are tumours, or growths, on or in the kidney. These growths can be benign or malignant.
Computed tomography of the abdomen and pelvis is an application of computed tomography (CT) and is a sensitive method for diagnosis of abdominal diseases. It is used frequently to determine stage of cancer and to follow progress. It is also a useful test to investigate acute abdominal pain. Renal stones, appendicitis, pancreatitis, diverticulitis, abdominal aortic aneurysm, and bowel obstruction are conditions that are readily diagnosed and assessed with CT. CT is also the first line for detecting solid organ injury after trauma.
A liver injury, also known as liver laceration, is some form of trauma sustained to the liver. This can occur through either a blunt force such as a car accident, or a penetrating foreign object such as a knife. Liver injuries constitute 5% of all traumas, making it the most common abdominal injury. Generally nonoperative management and observation is all that is required for a full recovery.
A pancreatic injury is some form of trauma sustained by the pancreas. The injury can be sustained through either blunt forces, such as a motor vehicle accident, or penetrative forces, such as that of a gunshot wound. The pancreas is one of the least commonly injured organs in abdominal trauma.
The genitourinary tract, or simply the urinary tract, consists of the kidneys, ureters, bladder, and the urethra. The kidney is the most frequently injured. Injuries to the kidney commonly occur after automobile or sports-related accidents. A blunt force is involved in 80-85% of injuries. Major decelerations can result in vascular injuries near the kidney's hilum. Gunshots and knife wounds and fractured ribs can result in penetrating injuries to the kidney.
Page kidney or Page phenomena is a potentially reversible form of secondary arterial hypertension caused by external compression of the renal parenchyma by some perirenal process. Any process that causes mass effect can be a potential cause of Page kidney. Hematomas, urinomas, tumors, cysts, lymphoceles, and aneurysms have all been reported in the literature. The compression is believed to cause activation of the renin–angiotensin–aldosterone system (RAAS) via microvascular ischemia.