1、Kidney TraumaDepartment of UrologyThe Peoples Hospital of Youyang CountyJunhui ShiDirectorylBackgroundlAnatomylEtiology lPathologylClinical findingslTreatmentlSummaryFunction of the kidneyProduce urine, excrete metabolites Maintain body fluid and acid-base balance Endocrine function: Renin, prostagl

2、andin Regulate blood pressure and balance blood lipidsEndocrine degrading hormoneBackgroundInjuries to urinary systemAbout 10% of all injuries in the emergency room involve the genitourinary systemMany of them are difficult to defineEarly diagnosis is essential to prevent serious complicationsBackgr

3、oundlBasic Pathological changel Shockl Urinary extravasationl Urinary obstruction (destruction) l Infection ,cost,deathAnatomylKidneylUreterlBladderlUrethraUrlThe kidney is well protected by heavy lumbar muscles, vertebral bodies, ribs, and the viscera anteriorlyEtiology lBlunt trauma directly to th

4、e abdomen, flank, or back is the most common mechanism for 8085% renal injurieslTraffic accidents, fights, falling, contact sports, and so on.lBlunt trauma: The force transmitted from the center of the impact to the renal parenchymalDeceleration: The kidney moves upward or downward,cause sudden stre

5、tch on the pedicle, acute renal artery injuries and thrombosis may occurlDirect or indirect violence at upper abdomen or flank area may cause kidney injure lFracture ribs and transverse vertebral processes may penetrate the renal parenchyma or vasculaturelGunshot and knife wounds cause penetrating i

6、njuries to the kidney* *Pathology Pathology lRenal contusion l (85% of cases)lSuperficial cortical lacerationslSubcapsular hematoma lPartial lacerationslInjuries extend to renal capsule or collecting systemlPerirenal hematomalHematurialDeep lacerationslInjuries extend both renal capsule and collecti

7、ng systemlExtravasation of urine into perirenal spacelLarge retroperitoneal hematomalHematurialVascular injury l(less than 1% )lVascular injury of renal pedicle is rarelDifficult to diagnosislEmergency operation should be done for saving lifelMortality is still highClinical findingslHistory of traum

8、alSymptoms:lPain may be localized to one flank area or over the abdomen associated to injurylMicroscopic or gross hematuria following trauma to the abdomen or flanklFever : infectionlSignslShock or signs of a large loss of blood from heavy retroperitoneal bleeding may be notedlPalpable mass may repr

9、esent a large retroperitoneal hematoma or urinary extravasationlDiffuse abdominal tendernesslLower ribs fracturelLaboratory findingslRed blood cells in urine: hematurialHematocrit may be normal initially,but a drop may be found with time pastlHCT dropping represents persistent retroperitoneal bleedi

10、ng and development of a large retroperitoneal hematomalUltrasonographylEasy lFastlNoninvasivelWell descript the parenchyma and hematoma of kidneyRadiology lIVU(intravenous urography, excretory urography)lFunction of separate sideslUrinary extravasationlEnhanced CT scanlAbdominal CT scan is the most

11、direct and effective means of staging renal injurieslClearly defines parenchymal lacerations and urinary extravasationlFirst choice for diagnosis renal injuriesRadiology Plain scanning periodVenous phasePortal venous phaseArterial phaseExcretory period lPlain scanning periodlVenous phaselArterial ph

12、aselExcretory periodlArteriographylDefines major arterial and parenchyma injurieslArterial thrombosis and avulsion of the renal pedicle are best diagnosislInvasive , choose carefullyRadiology lOtherslRetrograde urography : dangerous with infection, should not be chosen lMRI: noninvasive, as an alter

13、nate choice TreatmentlEmergency measureslResuscitation lTreatment of shock and hemorrhagelEvaluation associated injurieslMinor renal injuries from blunt trauma account for 85% of cases do not require operationl Renal contusionl Partial laceration*Non-operative treatmentBed rest for 24 weeksWatchful

14、waiting : vital signs, blood, urineHydration and nutrition Antibiotics for prevent infectionSymptomatic therapy：analgesic, sedative, hemostasislOperation indicationslPenetrating injuries:l (Penetrating abdominal injury require operation, renal exploration is only an extension of this procedure)lSeve

15、re blunt injuries:l Deep laceration l Multiple laceration l Renal pedicle injuriesl Persistent retroperitoneal bleeding , Severe urinary extravasation l lOperation indicationslDuring non-operation treatment : lAnti-Shock ineffective, or shock occurance againlHematuria get more severelMass of abdominal enlarged lHemoglobin and hematocrit keep decreasinglSuspicious of Abdom