Renal truma lecture

1. Renal Trauma
​Hanan Hassan
Radhi

2. Introduction
The kidneys are protected by the rib cage and
musculature of the back posteriorly and by a cushion
of abdominal wall and viscera anteriorly. They are
highly mobile and are fixed only at the renal pedicle
(stem of renal blood vessels and the ureter). With
traumatic injury, the kidneys can be thrust against the
lower ribs, resulting in contusion and rupture. Rib
fractures or fractures of the transverse process of the
upper lumbar vertebrae may be associated with renal
contusion or laceration. Failure to wear seat belts
contributes to the incidence of renal trauma in motor
vehicle crashes. Up to 80% of patients with renal
trauma have associated injuries of other internal
organs.
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3. Type of renal injure
 blunt (automobile and motorcycle crashes, falls, athletic
injuries, assaults)
 penetrating (gunshot wounds, stabbings).
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4. Blunt renal trauma is classified into one of
four groups, as follows:
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• Contusion: Bruises or hemorrhages under the renal
capsule; capsule and collecting system intact
• Minor laceration: Superficial disruption of the cortex;
renal medulla and collecting system are not involved
• Major laceration: Parenchymal disruption extending into
cortex and medulla, possibly involving the collecting
system
• Vascular injury: Tears of renal artery or vein The most
common renal injuries are contusions, lacerations,
ruptures, and renal pedicle injuries or small internal
lacerations of the kidney

5. Clinical manifestations
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pain
 renal colic (due to blood clots or fragments obstructing the
collecting system)
 hematuria
 mass or swelling in the flank
 ecchymoses
 lacerations or wounds of the lateral abdomen and flank.
Hematuria is the most common manifestation of renal trauma;
its presence after trauma suggests kidney injury

6. Medical management
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 control hemorrhage, pain, and infection as well as to preserve and restore renal function.
 All urine is saved and sent to the laboratory for analysis to detect RBCs and to evaluate the
course of bleeding.
 Hematocrit and hemoglobin levels are monitored closely; decreasing values indicate hemorrhage.
 The patient is monitored for oliguria and signs of hemorrhagic shock,
 An expanding hematoma may cause rupture of the kidney capsule. To detect hematoma, the area
around the lower ribs, upper lumbar vertebrae, flank, and abdomen is palpated for tenderness.
 A palpable flank or abdominal mass with local tenderness, swelling, and ecchymosis suggests
renal hemorrhage. The area of the original mass can be outlined with a marking pen so that the
examiner can evaluate the area for change.

7. Con…………….
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 the patient is assessed for skin abrasions, lacerations, and entry and exit wounds of the upper abdomen
and lower thorax, because these may be associated with kidney injury. With a contusion of the kidney,
healing may take place with conservative measures. If the patient has microscopic hematuria and a normal
IV urogram, outpatient management is possible. If gross hematuria or a minor laceration is present, the
patient is hospitalized and kept on bedrest until the hematuria clears.
 Antimicrobial medications may be prescribed to prevent infection from perirenal hematoma or urinoma (a
cyst containing urine).
 Patients with retroperitoneal hematomas may develop low-grade fever as absorption of the clot takes
place.

8. Surgical Management
 In renal trauma, any sudden change in the patient’s condition suggests hemorrhage and
requires rapid surgical intervention. Depending on the patient’s condition and the nature
of the injury, major lacerations may be treated through surgical intervention or
conservatively (bed rest, no surgery).
 Vascular injuries require immediate exploratory surgery because of the high incidence
of involvement of other organ systems and the serious complications that may result if
these injuries are untreated.
 The patient is often in shock and requires aggressive fluid resuscitation.
 The damaged kidney may have to be removed (nephrectomy).
 Early postoperative complications (within 6 months) include rebleeding, perinephritic
abscess formation, sepsis, urine extravasation, and fistula formation. Other complications
include stone formation, infection, cysts, vascular aneurysms, and loss of renal function.
Hypertension can be a complication of any surgery but usually is a late complication of
kidney injury. 8

9. Nursing Management
• The patient with renal trauma must be assessed frequently during the first few days after
injury to detect flank and abdominal pain, muscle spasm, and swelling over the flank.
• the patient who has undergone surgery is educated about care of the incision and the
importance of an adequate fluid intake,
• instructions about changes that should be reported to the physician, such as fever, hematuria,
flank pain, or any signs and symptoms of decreasing kidney function, are provided.
• Guidelines for gradually increasing activity, lifting, and driving are also provided in
accordance with the physician’s prescription.
• Follow-up nursing care includes monitoring the blood pressure to detect hypertension and
advising the patient to restrict activities for about 1 month after trauma to minimize the
incidence of delayed or secondary bleeding.
• The patient should be advised to schedule periodic follow-up assessments of renal function
(creatinine clearance, BUN, and serum creatinine analyses).
• If a nephrectomy was necessary, the patient is advised to wear medical identification.
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10. References
Brunner, L.S.,& Suddarth, D.S.(2004). Medical surgical nursing .Saunde
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