Renal and adrenal trauma

Dr Tim FotheringhamThe Royal London Hospital, UK

Nordic Trauma Society, Oslo 2008

Renal trauma

Renal trauma

• 1-5% of all traumas• Common in other settings

– Iatrogenic eg biopsy– Childbirth

• 80-95% are due to blunt trauma• Avulsion seen with vertical deceleration

Associated injuries

• Other organ injury seen in approx 75%• Spleen 25% with left kidney injury• Lower rib fractures• Lumbar spine injuries

Findings

• Haematuria• Flank pain• Rib/lumbar process fracture• Abrasion or bruising to the flank• Abdominal distention• Abdominal mass• Abdominal tenderness

Pre-existing renal disease

• Renal injury is more common with pre-existing renal disease

• Horseshoe kidney• Pelvic kidney• Renal cysts• Benign and malignant renal lesions

Sensitivity of imaging

• US 79%• IVP 91%• CT 96%• Comparison study 498 patients

– Qin R et al Chin J Traumatol 2002

Renal injuries• Use of Ultrasound

– May be diagnostic in children– Follow-up in children

• Ultrasound findings– Perirenal fluid– Hypoechoeic line– Loss of renal sinus echoes– Absence of doppler

CT findings

• Blurring of fat planes• Focal contusions• Subcapsular haematoma• Perirenal haematoma• Lacerations • Pseudoanuerysms/active bleeding• Devascularised kidney• PC leaks

Grading AAST• I Subcapsular haematoma or contusion• II Cortical laceration <1cm• III Cortical laceration >1cm• IV Deep laceration (may include collecting

system)Segmental infarction

• V Multiple major lacerationsAvulsionVenous thrombosis

Grade I

Grade II

Grade III

Grade IV

Grade V

Isolated penetrating trauma

• Frequently iatrogenic• Angiography indicated for haemorrhage

control• Aneurysms and AVM can frequently be

managed using endovascular techniques

Penetrating injury to loin

Ureteric injuries

• <1% of urological injuries

• 5% with pelvic fracture

• 17% have haematuria• Nephrostomy and

ureteric stenting• Cystoscopic stening• Surgery

Adrenal injury

• Haemorrhage common• Usually incidental observation

Conclusion

• Renal injuries are common• 80% Grade I-III• Non operative management • Surgery indicated for haemorrhage control• Nephrostomy indicated for leak from

collecting system

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