Renal Trauma Pediatric GU Review UCSD Pediatric Urology George Chiang MD Sara Marietti MD Outlined from  The Kelalis-King-...
 
Pediatric Renal Trauma <ul><li>Most commonly injured abdominal organ in blunt trauma </li></ul><ul><ul><li>Fetal lobulatio...
Pediatric Renal Trauma <ul><li>Shock unreliable indicator of significant injury </li></ul><ul><li>Controversy exists when ...
Mechanisms of Injury <ul><li>Blunt trauma </li></ul><ul><ul><li>85-95% of renal trauma </li></ul></ul><ul><ul><li>Direct b...
Mechanisms of Injury <ul><li>Penetrating trauma </li></ul><ul><ul><li>~ 10% of renal trauma </li></ul></ul><ul><ul><li>Gun...
Pediatric Renal Trauma <ul><li>Preexisting renal abnormalities (i.e. UPJ Obstruction, hydro, horseshoe kidney) are 3-5 X m...
American Association for the Surgery of Trauma  Organ Injury Severity Scale for the Kidney Moore, Shackford, J Trauma, 198...
Organ Injury Scale
Hematuria in Children <ul><li>Unreliable in determining who to screen for renal injuries </li></ul><ul><li>Some studies ha...
Radiographic Trauma Assessment <ul><li>1. All penetrating abdominal trauma,  </li></ul><ul><li>2. Blunt trauma victims who...
J Pediatr Surg. 2002 May;37(5):779-82  Chopra P ,  et al. ( Montreal, Quebec) <ul><ul><li>PURPOSE: quantify pathologic les...
Brown SL , et al. in World J Surg. 2001 Dec;25(12):1557-60  Radiologic evaluation of pediatric blunt renal trauma in patie...
<ul><li>Methods: </li></ul><ul><ul><li>14,763 pts reviewed </li></ul></ul><ul><li>Results: </li></ul><ul><ul><li>193 with ...
Master, McAnich; Urol Clin N Am, 2006
Master, McAnich; Urol Clin N Am, 2006
Master, McAnich; Urol Clin N Am, 2006
Master, McAnich; Urol Clin N Am, 2006
Master, McAnich; Urol Clin N Am, 2006
Upcoming SlideShare
Loading in...5
×

Pedi gu review renal trauma

610

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
610
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
34
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • Pathophysiologically, shearing forces exceed the tensile strength of renal parenchyma Handguns are low velocity of &lt;1000 ft/s and assault rifles are considered high velocity of &gt;1000 ft/s Blast effect from a projectile may cause delayed tissue necrosis, leading to bleeding, urine leak, or abcess
  • Pathophysiologically, shearing forces exceed the tensile strength of renal parenchyma Handguns are low velocity of &lt;1000 ft/s and assault rifles are considered high velocity of &gt;1000 ft/s Blast effect from a projectile may cause delayed tissue necrosis, leading to bleeding, urine leak, or abcess
  • Unclear if children have increased risk of renal injury after blunt trauma. Classically, hydronephrotic kidneys were thought to be more prone to injury from trauma.
  • 1.  A significant deceleration or high-velocity injury such as one sustained in a high-speed motor vehicle accident, a pedestrian/bicycle-motor vehicle accident, a fall from more than 15 feet, or a strike to the abdomen or flank with a foreign object (e.g., football helmet, baseball bat) 2.  Significant trauma that has resulted in fractures of thoracic rib cage, spine, pelvis, or femur, or bruising of the torso/perineum, or signs of peritonitis   3.  Gross hematuria 4.  Microscopic hematuria (&lt;50 red blood cells per high-powered field) associated with shock (systolic blood pressure less than 90 mm Hg)
  • Two heterogeneous renal masses were discovered in which the diagnosis of a malignant process could not be eliminated; elective resection and open biopsy were performed. The diagnoses of multicystic kidney and solitary cyst with complex hematoma, respectively, were confirmed on pathology. Grade III ureterovesical reflux with pyelonephritis (n = 1), polycystic kidney (n = 1), extrarenal pelvis without obstruction (n = 1), and horseshoe kidney (n = 1) were the other lesions
  • World J Surg. 2001 Dec;25(12):1557-60 Radiologic evaluation of pediatric blunt renal trauma in patients with microscopic hematuria. Brown SL , Haas C , Dinchman KH , Elder JS , Spirnak JP .Department of Urology, Rainbow Babies and Children&apos;s Hospital, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio 44106, USA. sbrown2200@home.com
  • Pedi gu review renal trauma

    1. 1. Renal Trauma Pediatric GU Review UCSD Pediatric Urology George Chiang MD Sara Marietti MD Outlined from The Kelalis-King-Belman Textbook of Clinical Pediatric Urology 2007 (not for reproduction, distribution, or sale without consent)
    2. 3. Pediatric Renal Trauma <ul><li>Most commonly injured abdominal organ in blunt trauma </li></ul><ul><ul><li>Fetal lobulations predispose to renal separation </li></ul></ul><ul><ul><li>Less protection by pliable thoracic cage and less developed musculature </li></ul></ul><ul><ul><li>Higher incidence of pedicle injury </li></ul></ul><ul><li>80% with renal injury have associated nonrenal injuries </li></ul>
    3. 4. Pediatric Renal Trauma <ul><li>Shock unreliable indicator of significant injury </li></ul><ul><li>Controversy exists when to image pediatric renal trauma patients. </li></ul><ul><li>Some advocate imaging ALL children with microscopic hematuria </li></ul><ul><li>Dr. Morey and others have suggested observation in stable patients with <50rbc/hpf and mild trauma </li></ul>
    4. 5. Mechanisms of Injury <ul><li>Blunt trauma </li></ul><ul><ul><li>85-95% of renal trauma </li></ul></ul><ul><ul><li>Direct blow / Assault </li></ul></ul><ul><ul><li>Bony spicules of ribs or vertebrae </li></ul></ul><ul><ul><li>MVA: speed; driver, passenger, degree of deceleration </li></ul></ul><ul><ul><li>Falls </li></ul></ul>Giambologna, Hercules and the Centaur, 1550
    5. 6. Mechanisms of Injury <ul><li>Penetrating trauma </li></ul><ul><ul><li>~ 10% of renal trauma </li></ul></ul><ul><ul><li>Gunshot injury from bullet, </li></ul></ul><ul><ul><li>fragments, or blast effect </li></ul></ul><ul><ul><li>Stab wounds: size of knife </li></ul></ul><ul><ul><li>KE = ½ MV 2 </li></ul></ul>Mantegna, St. Sebastian, 1470
    6. 7. Pediatric Renal Trauma <ul><li>Preexisting renal abnormalities (i.e. UPJ Obstruction, hydro, horseshoe kidney) are 3-5 X more common in peds patients undergoing screening CT for trauma than in adults </li></ul><ul><li>Classically, congenital renal abnormality presents with hematuria disproportionate to severity of trauma </li></ul>( Chopra et al, 2002 ; McAleer et al, 2002 ; Heyns, 2004 ; Santucci et al, 2004 ).
    7. 8. American Association for the Surgery of Trauma Organ Injury Severity Scale for the Kidney Moore, Shackford, J Trauma, 1989 Grade Description of Renal Injury I  Contusion : hematuria with normal radiological studies. Hematoma : subcapsular and non expanding.  II  Hematoma  : perirenal ,confined to retroperitoneum.  Laceration  :  < 1 cm depth without extravasation III Laceration  :  > 1cm depth without collecting system injury or extravasation.  IV Laceration : through renal cortex, medulla, collecting system.    Vascular : renal artery or vein injury : contained hemaorrhage.  V Laceration : shattered destroyed kidney    Vascular    : renal arterial and venous avulsion. 
    8. 9. Organ Injury Scale
    9. 10. Hematuria in Children <ul><li>Unreliable in determining who to screen for renal injuries </li></ul><ul><li>Some studies have failed to find any evidence of either gross or microscopic hematuria in up to 70% of children sustaining grade 2 or higher renal injury. </li></ul><ul><li>Hematuria alone cannot determine need for radiographic studies </li></ul>( Morey et al, 1996 ; Buckley and McAninch, 2004 ).
    10. 11. Radiographic Trauma Assessment <ul><li>1. All penetrating abdominal trauma, </li></ul><ul><li>2. Blunt trauma victims who have either: </li></ul><ul><li>Significant deceleration or high-velocity injury </li></ul><ul><li>fractures of thoracic rib cage, spine, pelvis, or femur, or bruising of the torso/perineum, or signs of peritonitis   </li></ul><ul><li>Gross hematuria </li></ul><ul><li>Microscopic hematuria (>50 red blood cells per high-powered field) and shock (SBP<90mm Hg) </li></ul>Santucci and associates (2004a)
    11. 12. J Pediatr Surg. 2002 May;37(5):779-82 Chopra P , et al. ( Montreal, Quebec) <ul><ul><li>PURPOSE: quantify pathologic lesions of the kidney found incidentally during blunt trauma w/u </li></ul></ul><ul><ul><li>METHODS: Retrospective review of 103 patients (0 to 18 years) with blunt renal injuries. </li></ul></ul><ul><ul><li>US in all cases and CT as indicated </li></ul></ul><ul><ul><li>RESULTS: Coexisting urogenital lesions were identified in 13 of 103 (12.6%) patients, and 7 (54%) required surgical treatment. </li></ul></ul><ul><ul><li>Majority - 9 of 13 (69%) suffered minimal trauma. </li></ul></ul><ul><ul><li>Gross hematuria was main symptom. </li></ul></ul><ul><ul><li>UPJ Obstruction was most common anomaly </li></ul></ul><ul><ul><li>CONCLUSIONS: Pathologic lesions of the urinary tract are uncommon; however, they may complicate an otherwise negligible renal trauma. </li></ul></ul>
    12. 13. Brown SL , et al. in World J Surg. 2001 Dec;25(12):1557-60 Radiologic evaluation of pediatric blunt renal trauma in patients with microscopic hematuria. <ul><ul><li>Reviewed 1200 children with blunt abdominal trauma, 35 had CT </li></ul></ul><ul><ul><li>Results </li></ul></ul><ul><ul><li>3 with grade II-V renal injuries, 32 were normal or had renal contusions </li></ul></ul><ul><ul><li>1/3 patients with gross hematuria evaluated with CT sustained significant renal injury without other associated injuries. </li></ul></ul><ul><ul><li>Conclusions: </li></ul></ul><ul><ul><li>The degree of hematuria did not correlate with the grade of renal injury. </li></ul></ul><ul><ul><li>Pediatric patients with blunt trauma, microscopic hematuria, and no associated injuries do not require radiologic evaluation, as significant renal injuries are unlikely. </li></ul></ul><ul><ul><li>However, children who present with associated injuries and microscopic hematuria after blunt trauma may have significant renal injuries and should undergo radiologic evaluation. </li></ul></ul>
    13. 14. <ul><li>Methods: </li></ul><ul><ul><li>14,763 pts reviewed </li></ul></ul><ul><li>Results: </li></ul><ul><ul><li>193 with imaging or direct evidence of renal injury at surgery (32) </li></ul></ul><ul><ul><li>69% had associated injuries </li></ul></ul><ul><ul><li>17 (8.3%) congenital GU anomalies found in series </li></ul></ul><ul><li>CONCLUSIONS: </li></ul><ul><ul><li>1.3% of pediatric trauma pts have renal injuries </li></ul></ul><ul><ul><li>8.3% had congenital anomalies </li></ul></ul><ul><ul><li>UPJ Obstruction was most common abnormality (~33%) </li></ul></ul><ul><ul><li>Congenital anomalies may not increase risk of morbidity due to renal trauma </li></ul></ul>
    14. 15. Master, McAnich; Urol Clin N Am, 2006
    15. 16. Master, McAnich; Urol Clin N Am, 2006
    16. 17. Master, McAnich; Urol Clin N Am, 2006
    17. 18. Master, McAnich; Urol Clin N Am, 2006
    18. 19. Master, McAnich; Urol Clin N Am, 2006
    1. A particular slide catching your eye?

      Clipping is a handy way to collect important slides you want to go back to later.

    ×