Kidney trauma.pptxTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTT

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1. Kidney trauma Moderator- DR Gashaw Presenter- Ephrem

2. Outline Mechanism Presentation Investigation Grading Management Complication

3. M echanism Of all trauma case around 10% involve the urologic system, mostly renal Blunt trauma 90%( rapid deceleration forces) Penetrating trauma 10%

4. Signs and symptoms Flank pain, tenderness, bruising Gross hematuria /may be delayed Flank mass Hypotention Lower rib fracture/ transverse process of vertebre fracture Entry and exit wound crossing abdomen Meteorism

5. Who need imaging? Gross hematuria All penetrating injuries to the flank and abdomen Blunt trauma & microhematuria - if BP<90mmhg or shock All children with blood in urine with blunt injury (high cathecholamine levels keep BP normal untill ~ 50% blood loss)

6. Investigation IVP US - for serial follow up in high grade injuries CT scan- 95% sensitivity & best for grading U/A CBC

7. grading Grade Description of Injury 1 Contusion (normal imaging despite microscopic or macroscopic hematuria ) / nonexpanding subcapsular hematoma /No laceration 2 Nonexpanding perirenal hematoma or Cortical laceration <1 cm deep without extravasations of urine 3 Cortical laceration >1 cm without involving collecting system and no urinary extravasation

8. Grade 4 Laceration: through cortex, medulla, collecting system with extravasation of urine Vascular: main renal artery or vein injury with contained hematoma 5 Laceration: shattered kidney or Vascular: renal pedicle injury or avulsion

9. Management-blunt trauma Conservative mgt in majority of patients 90-95% are minor injuries Surgery in major trauma(5-10%)

10. Management- Penetraing injury Grade 1-2 observe Grade 3-4 observe if they do not need exploration for associated injuries Explore all vascular injuries & Grade 5 Make sure contralateral kidney is present & working

11. Conservative management Conservative secure double IV line, blood group & cross match Bed rest in pt with gross hematuria /strict activity 1wk after urine clears analgesic and prophylactic antibiotic Vital sign every 1HR Urgent imaging(grading), CBC, U/A

12. Complication hemorrhage Clot retention Urinary extravasation/ uirnoma Abscess formation renal infarction HTN

13. Pararenal pseudo hydronephrosis Post traumatic aneurysm of renal A Arteriovenous fistula

14. References Schwartz principle of surgery 10th edition Bailey & loves 26th edition