Kidney Trauma: Causes, Symptoms & Treatment

Kidney trauma is an injury to the kidneys. Such trauma can be caused by blunt force, for example. Many kidney traumas result from accidents during sports or traffic accidents.

What is kidney trauma?

Trauma in medicine is a term for a wounding of organ tissue. This wounding results from external force. In renal trauma, consequently, the kidneys are affected by such an injury caused by external force. Kidney trauma usually does not occur in isolation, but in conjunction with other injuries. Depending on the origin, a distinction can be made between open and closed kidney injuries. Classifications also exist to classify the extent of the injuries.

Causes

The main causes of closed kidney trauma include traffic accidents and accidents during sports. Open kidney trauma results from stab wounds or gunshot wounds. In this case, the injuries not only harm the affected person directly by injuring the kidney tissue, but also have an indirect negative impact on the entire organism. Thus, indirect effect such as blood loss can cause damage. In most cases, kidney trauma occurs together with other injuries. In blunt abdominal trauma, kidneys are involved in up to 40 percent of all cases. Eighty percent of all kidney injuries are polytrauma. In Europe, open kidney injuries are a rarity. In the USA, on the other hand, they play a greater role. Here, kidney trauma from gunshot wounds dominates.

Symptoms, complaints, and signs

Depending on severity, renal trauma can be divided into renal contusion, renal rupture, and organ disruption or renal pedicle rupture. Renal contusion occurs in 70 percent of cases. Renal ruptures are found in 20 percent of all cases, and about 10 percent of renal trauma involves organ disruption. In a renal contusion, the kidney is bruised or crushed. However, the renal capsule is still intact. There is no hematoma behind the peritoneum. In a rupture, the functional tissue of the kidney is torn. The organ capsule is also ruptured, allowing blood to leak into the retroperitoneal space. This causes a retroperitoneal hematoma to form. In more severe ruptures, the urinary filtering and urinary draining structures of the kidney may also be affected by the injury. In such cases, there is leakage of urine into the retreoperitoneal space and also loss of function of the kidney. In the case of organ disruption, the kidney is completely ruptured. Function fails and severe internal bleeding occurs.

Diagnosis and course of the disease

The main symptom of renal trauma is pain in the flank area. Depending on the trauma, these may be rather mild or very severe. Swelling may be visible in the flank area. This is then also referred to as a flank tumor. The flank may also be bluish in color due to a hematoma. In addition, blood may be visible in the urine (macrohematuria). In this case, the extent of the injury cannot be inferred from the amount of blood found in the urine. If the ureter is obstructed by a blood clot or is even torn off, the blood in the urine may be completely absent despite the severity of the injury. The injury results in abdominal guarding and possibly a palpable mass. Depending on how much blood is lost, individuals may experience shock.

Complications

In the worst case, renal trauma can lead to complete renal failure and death of the affected person. In this case, the patient is then dependent on permanent dialysis or on a kidney transplant. If no treatment is given, the kidney trauma usually leads to the death of the affected person. Sufferers of kidney trauma also suffer from very severe pain, which usually continues to spread to the back or other parts of the body. Internal bleeding and hematomas may also occur in the process and continue to significantly reduce the sufferer’s quality of life. Should the trauma to the kidney be mild, it is possible that the function of the kidney may be impaired. In many cases, the area around the kidneys is significantly swollen and there is flank pain. The urine usually also turns red as a result.No particular complications occur during the treatment. In severe cases, the life of the affected person can be saved by transplanting the kidney. However, it is possible that the patient’s life expectancy will still be reduced due to the kidney trauma.

When should you go to the doctor?

If kidney trauma is suspected, a doctor should be consulted immediately. If severe kidney pain is noticed after a blow to the kidneys or after an accident or fall, this indicates such trauma. If there is swelling or bleeding, there may be more severe kidney trauma, which also needs to be treated immediately. Affected persons should call an emergency physician or go to a hospital. There, the kidney injury can be diagnosed and treated immediately. Individuals who are unable to move due to the kidney injury must receive emergency medical care, as there may be a shattered kidney with torn renal vessels. Fifth-degree renal trauma requires inpatient treatment. Even after this, close medical monitoring is necessary so that the necessary measures can be initiated quickly in the event of any complications. In addition to the primary care physician, a nephrologist or other internist can treat the renal trauma. Severe trauma may require surgical intervention. Kidney trauma followed by kidney failure is a serious medical emergency that requires inpatient treatment in a hospital in any case. The sufferer requires several months of rest and recuperation, combined with regular visits to the doctor and extensive physiotherapy. If the kidney trauma was preceded by an accident, trauma therapy may also be necessary.

Treatment and therapy

Initial clues to renal trauma are provided by the presenting symptoms and the presence of a traumatic event. First, a thorough physical examination is performed. The abdominal cavity is palpated, and the renal region is also palpated with extreme caution. Hematomas or swellings may already be visible during the inspection. An ultrasound examination reveals possible bruising and renal tissue injury. The exact morphology of the injury can thus be seen. If a kidney rupture is present, a computer tomography scan is also performed. This is the only way to determine the extent of the rupture. Possible urinary leaks (extravasations), perfusion of renal fragments and concomitant injuries to the spleen and liver become visible. The condition of the opposite kidney can also be better assessed. If CT is not available, contrast imaging of the kidney should be performed.

Outlook and prognosis

The prognosis of renal trauma depends on the type and extent of damage. Mild-to-moderate renal lesions have the best chance of complete recovery if they are treated without complications. In the case of severe damage to kidney tissue or blood vessels, preservation of the kidney is often not possible: if only one kidney is affected, the remaining kidney usually takes over its function without significant restrictions. The prognosis worsens if complications such as bleeding or bruising occur immediately after surgery. Particularly in the case of multiple injuries to the organ, the penetration of bacteria can lead to life-threatening blood poisoning (sepsis); appropriate therapy with antibiotics minimizes this risk considerably. As a late consequence of kidney trauma, loss of function occurs (according to Rassweiler) in ten percent of all cases. In one to five percent of those affected, renal hypertension develops, and one percent develops a shrunken kidney. Two percent of patients subsequently suffer from kidney stones (nephrolithiasis), and one to eight percent complain of recurrent urinary tract infections. Regular and carefully performed follow-up examinations such as urine tests, ultrasound examinations and blood pressure checks can help to detect secondary damage at an early stage and treat it accordingly at an early stage.

Prevention

Therapy for renal trauma depends on the type of injury and the degree of injury. Thus, whether the injury is open or closed is important for the choice of therapy. Possible concomitant injuries and the patient’s general condition and circulatory situation also play a role. Open stab and gunshot wounds are always treated surgically.This is the only way to ensure that other organs are not affected. A renal contusion is usually treated conservatively with painkillers. In addition, the affected person must rest and avoid further trauma at all costs. What is the best treatment for a kidney rupture is controversial. Conservative treatment is possible, provided there is no renal pedicle rupture. However, this requires a CT scan to determine the extent. After three to six days, a second CT is obtained. If no improvement is seen, surgery must be performed. It may be necessary to remove part or all of the kidney. Intervention is also required if the circulation is permanently destabilized or if bacterial sepsis is imminent. In many cases, however, kidney trauma can be controlled by minimally invasive treatment methods, so that many patients are spared (partial) removal of the kidney. Kidney trauma is difficult to prevent. For motorcyclists, a kidney belt may be able to protect against injury in the event of an accident. Back protectors also offer protection.

Aftercare

In most cases, conservative aftercare is sufficient. This includes strict bed rest and prophylactic administration of an antibiotic. Bed rest should be maintained until a marked decrease in hematoma is observed. The antibiotic should counteract infection of the hematoma or urinoma. In addition, close monitoring of pulse, blood pressure, temperature, blood count, and retention values is recommended. In the further course, a control by ultrasound and computer tomography follows. The ultrasound examination should be performed every one to three days, depending on the clinical picture. After two weeks, after four weeks and after three months, the data are recorded with the aid of the computer tomograph. In many cases, it is advisable to determine the kidney function by means of scintigraphy. In this case, the kidney can be explicitly examined with the help of an intravenous administration of radioactive substances. The focus here is on the time course from uptake to excretion of the radiating substance. After the inpatient stay, all the follow-up examinations described above can be carried out by the resident urologist to monitor the healing process. It should be noted that the external application of heat is counterproductive. This includes hot showers or baths in addition to saunas.

This is what you can do yourself

If kidney trauma is suspected, a doctor should be consulted first. In any case, the condition requires specialist treatment in the hospital, because otherwise it can lead to serious complications and, in the worst case, even death of the patient. Kidney trauma is usually treated surgically. Following the operation, the patient must remain in bed and take it easy. If necessary, the diet must also be changed so that the kidneys are not subjected to any further stress. Affected persons should also not engage in sports until the injury has healed completely. In consultation with a sports physician or physiotherapist, light exercises from the field of physiotherapy may be performed. A severe kidney trauma can result in permanent impairments, which often place a psychological burden on the affected person as well. It is advisable to seek discussion with other affected persons and also to take measures to overcome the psychological trauma. Since kidney trauma is always a serious injury, further self-help measures should be avoided. In individual cases, therapy can be supported by natural painkillers from the field of naturopathy.