RENAL TRAUMA

The kidney is the most commonly injured organ in the urological system. Although the kidney is well protected by heavy lumbar muscles, vertebral bodies, ribs and other abdominal organs can be injured. There are two mechanism of injury to the kidney:

• Blunt trauma
• Gunshot and stable wounds

Blunt trauma:

• Automobile accidents
• Falls
• Contact sports
• Assaults

Symptoms:

• Gross or microscopic hematuria
• Abdominal tenderness
• Rib or vertebral body fractures
• Flank contusion
• Palpable abdominal mass
• Shock

Classification of renal injuries:

• Renal contusions
• Minor lacerations
• Minor parenchymal lacerations
• Paqrenchymal laceration extending through the renal cortex
• Completely shattered kidney 

Diagnosis:

• History and physical examination
• CT scan
• Intravenous pyelography
• Angiography

Management:

• Prompt treatment of shock and hemorrhage
• Management of other injuries
• Most blunt trauma to the kidney can be managed conservatively and do not require an operation
• Absolute indication for operative intervention include – expanding and pulsatile hematoma

Penetrating renal trauma:
Penetrative injuries should be surgically explored. In 80% of cases of penetrating renal injury and associated organ injury also exist.