Renal Trauma

 The kidneys aren’t only vulnerable to disease but also to trauma, being the most commonly
injured organ of the genitourinary system often in concomitance with other injuries. It can be
damaged either through blunt or penetrating forces, with blunt being more common. Motor
vehicle accidents predominate in adults while falls are of highest incidence in pediatric
population. Acceleration-deceleration forces are the underlying elements, and pre-existing
kidney conditions predispose the kidneys to dysfunction. Penetrating trauma on the other hand,
are mainly caused by firearms and stab wounds. Projectile velocity and the structures hit
determine the extent of damage.
 Clinical evaluation and imaging studies are needed in patient assessment. Being an emergency
condition, initial assessment of renal trauma begins with the primary survey to assess for
potential life-threatening problems. Once the patient has been stabilized, more detailed
examination can be performed with history taking, physical examination and routine laboratory
tests. History will mainly investigate for mechanism of injury and pre-existing conditions that
may increase the risk of damage. Physical examination can reveal the location and extent of
injury. Laboratory tests can assess for bleeding, hematuria being a common finding, baseline
renal function, as well as the possibility of other abdominal organ injuries. Additional diagnostic
procedures are then requested depending on the indications as well as availability, with
contrast-enhanced CT being the gold standard for hemodynamically stable patients. Different
phases of CT scan can identify a wide range of conditions. IV pyelography and ultrasound are
also used with limited indications. Timing of imaging is also important, with initial imaging
aiming to grade the injury, demonstrate the contralateral kidney as well as identify other
conditions and injuries. Re-imaging in contrast aims to assess for complications and
deterioration.
 The type and severity of kidney injury, as exemplified by the American Association for Surgery of
Trauma (AAST) classification, will determine what treatment will be needed by the patient. It is
also a reliable way of predicting morbidity and mortality. With the current knowledge and
technique advancements, non-operative management has become more advantageous than
operative management in both pediatric and adult patients. It mainly consists of observation,
supportive care, and minimally invasive procedures, with angioembolization effective even in
higher grade injuries. Surgical management however is considered in hemodynamically unstable
patients who don’t respond to resuscitation. If complications do occur, they can either be early
or delayed, but most can still be managed non-operatively. Overall, treatment of renal trauma
aims as much as possible to avoid mortality, kidney dysfunction, and complications.