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Renal Trauma

Renal injuries developing due to blunt or penetrating abdominal-flank trauma and graded by AAST classification.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Üroloji department. Book Appointment →

What is Renal Trauma?

Renal trauma accounts for approximately 65% of all genitourinary trauma, and most cases develop after blunt abdominal or flank trauma. Traffic accidents, falls from height, blows, and sports injuries are the most common causes of blunt trauma; penetrating injuries (gunshot, stabbing) lead penetrating trauma. Male sex and age 20-40 are the most affected group.

Injuries are graded into 5 levels by the American Association for the Surgery of Trauma (AAST) renal injury scale. Grades I-II describe minor contusion and superficial lacerations, grade III deep parenchymal laceration, grade IV collecting system or vascular injury, and grade V shattered kidney or vascular pedicle avulsion.

In the current approach, contrast-enhanced CT is the standard imaging method in hemodynamically stable patients. Thanks to selective non-operative management (SNOM) and angiographic embolization, organ preservation rate exceeds 90% in low-grade injuries. Surgery is mandatory only in hemodynamic instability and grade V injuries.

Symptoms

Flank pain and tenderness
Macroscopic or microscopic hematuria (blood in urine)
Bruising and swelling on the flank
Lower rib fractures and flank ecchymosis on physical examination
Hypotension and tachycardia (advanced injury)
Distension and guarding from intra-abdominal bleeding
Palpable mass from retroperitoneal hematoma

Risk Factors

High-energy traffic accident and motorcycle crash
Falls from height and work accidents
Contact sports (football, boxing, martial arts)
Penetrating injuries (gunshot, stab)
Pre-existing renal anomalies (pelvic kidney, horseshoe kidney, cyst, or tumor)
Relatively larger kidney size in pediatric age group
Anticoagulant use

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Pain and blood in urine after a blow to the flank
  • Flank pain and lower rib tenderness after a traffic accident
  • Severe flank pain along with hypotension
  • Bleeding and shock findings after a penetrating injury
  • Hematuria even after minor trauma in children

Treatment Methods

01
Hemodynamic assessment, fluid and blood product resuscitation
02
AAST grading with contrast-enhanced CT
03
Bed rest and observation (SNOM) in grades I-III and selected grade IV cases
04
Selective angiographic embolization for active bleeding or pseudoaneurysm
05
Surgical exploration and renorrhaphy: hemodynamic instability, grade V injury
06
Nephrectomy: last resort in uncontrollable bleeding and shattered kidney injury

Which Department to Visit?

You can visit our Üroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.