Management of Blunt Renal Trauma

Kristjánsson, A.; Jh, Pedersen

doi:10.1111/j.1464-410x.1993.tb16249.x

Cited by 58 publications

(40 citation statements)

References 21 publications

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“…In two large series, [29,30] there was a 98% success rate for TPND, with a 5.6-6% complication rate in patients with urinary obstruction or urinary fistulae in an emergency setting. Although urinary extravasation and urinoma have been a relative indication for surgical approach [7,31], we do not consider that urinary extravasation alone, with no haemodynamic instability, obstruction or expanding urinoma, warrants initial surgery in these children. Kase et al [32] suggested that expectant management of blunt renal trauma might be reliable if the patient is stable, even if there is rupture.…”

Section: Discussionmentioning

confidence: 99%

Blunt renal trauma in children with previously undiagnosed pre‐existing renal lesions and guidelines for effective initial management of kidney injury

Önen¹,

Kaya²,

Çığdem³

et al. 2002

BJU International

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Objectives To record pre-existing renal lesions (PERL) found incidentally during evaluation for blunt renal trauma in children, determine their importance, suggest guidelines for the effective initial management of children with significant renal trauma and to evaluate the role of temporary percutaneous nephrostomy tube drainage (TPND) in these patients. Patients and methods We reviewed 338 children who were hospitalized with blunt abdominal trauma between 1992 and 2000. Thirty-one patients had significant renal injury, 17 before 1997 (reviewed retrospectively) and the others reviewed and followed prospectively. Results Eleven of the 31 children had a PERL, which had been undiagnosed before the injury. The mean (range) follow-up was 52 (15-104) months. There were 22 boys and nine girls (mean age 9.1 years, range 2-13).The mean age was lower in patients with a PERL than in children with isolated renal injury. The most common cause of blunt renal injuries was a fall (45%) followed by motor vehicle accidents. Renal stones were present in five children, pelvi-ureteric junction obstruction in four, megaureter in one and a renal cyst in one. The mean injury severity scores were 12in the children with a PERL and 14 in patients without. TPND was used in seven (22%) children; four were associated with a PERL. The mean grade of injury score for the kidney was higher in patients with a PERL and in children who underwent TPND than in patients who previously had a normal kidney and in children who did not undergo TPND. Early surgical intervention was required in three children; all were associated with a PERL. Of the 13 children who underwent surgery 11 had previous disease. Conclusions The frequency of PERL is high (36%) in children with blunt renal trauma. PERL can predispose minor trauma to cause kidney injury even with no evidence of hydronephrosis. When a minor trauma results in renal injury, it is important to seek a PERL.In selected patients, TPND may decrease the length of hospital stay and improve the outcome of the injured kidney, thereby decreasing the need for further surgery in those with isolated renal injury; however, it appears not to decrease the need for later operations in children with a PERL.

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Section: Discussionmentioning

confidence: 99%

Blunt renal trauma in children with previously undiagnosed pre‐existing renal lesions and guidelines for effective initial management of kidney injury

Önen¹,

Kaya²,

Çığdem³

et al. 2002

BJU International

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“…Los defensores del tratamiento quirúrgico inmediato 21,22 aducen que el tratamiento conservador se asocia a una elevada incidencia de hemorragias secundarias. Además el urohematoma puede infectarse dando lugar a la formación de abcesos u organizarse produciendo la compresión de la vía urinaria con ureterohidronefrosis secundaria, atrofia renal o hipertensión arterial, incrementándose pues la tasa de complicaciones tanto precoces como tardías.…”

Section: Discussionunclassified

Manejo conservador de los traumatismos renales de alto grado

Oliva

García

Pérez

et al. 2007

Actas Urológicas Españolas

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RESUMEN MANEJO CONSERVADOR DE LOS TRAUMATISMOS RENALES DE ALTO GRADOIntroducción: Los traumatismos genitourinarios constituyen el 8-10% de los traumatismos abdominales y en el 50% de los casos es el riñón el órgano más afectado, sobretodo el izquierdo. La decisión de adoptar un tratamiento conservador o quirúrgico en estos casos dependerá del tipo de lesión que encontremos en la unidad renal afecta y de las condiciones clínicas del paciente.Objetivo: Los objetivos del estudio son determinar la posibilidad de llevar acabo un tratamiento conservador en los traumatismos renales de alto grado y estudiar la evaluación y aparición de complicaciones en los mismos.Material y métodos: Hemos analizado retrospectivamente los 309 casos de traumatismos renales acontecidos en nuestro Servicio en el período de tiempo comprendido entre Enero 1984 y Enero 2006, estudiando variables como la etiología del traumatismo, lesiones asociadas en otros órganos, actitud terapéutica adoptada y presencia de complicaciones, tanto a largo como a corto plazo.Resultados: De los 309 traumatismos renales analizados, el 94,1% (291 casos) fueron traumatismos renales cerrados o contusos. La distribución por grados del total de traumatismos fue: Grado I: 213 casos (69%), grado II: 39 casos (12.6%), grados III y IV: 32 casos (10,3%) y grado V: 25 casos (8%). Realizamos tratamiento conservador en el 84,6% de los casos etiquetados como grados III y grado IV (24 casos en total). Se practicaron 4 nefrectomías de urgencia en los grado III por inestabilidad hemodinámica y 4 nefrectomías en grados IV por el mismo motivo, una de ellas parcial, diferidas a las 48-72 horas del traumatismo. En 67% de los traumatismos grado V se realizó nefrectomía de urgencia.Conclusiones: De acuerdo a nuestra experiencia y a los resultados obtenidos, consideramos adecuado el manejo conservador en los traumatismos renales de alto grado siempre y cuando las condiciones hemodinámicas del paciente lo permitan.Palabras clave: Traumatismo. Renal. Conservador. ABSTRACTCONSERVATIVE APPROACH IN MAJOR RENAL TRAUMA Introduction: Genitourinary trauma amount to an 8-10% of abdominal trauma with the kidney being the most affected organ in 50% of cases, especially the left one. The choice of treatment will depend on the kind of lesion found in the affected renal unit and on the patient's clinical conditions.Objective: The aims of this study are twofold: to determine the applicability of conservative treatment in major renal trauma and to assess the evaluation and emergence of possible complications.Material and methods: We have analysed 309 cases of renal trauma dealt with in our department between January 1984 and January 2006, analyzing such variables as the etiology of the trauma, associated lesions in other organs, the therapeutic approach adopted as well as the presence of complications, both in the long and short run.Results: Out of a total of 309 renal trauma analyzed, a 94,1% (291 cases) were blunt renal trauma. The distribution by grade was: Grade I, 213 cases (69%); Grade II, 39 cas...

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“…[1][2][3][4] The kidneys are the most frequently injured organs when genitourinary system injuries are considered, and renal injury is recorded in approximately 1-5% of all the injuries. [5,6] Clinical findings are not manifest in 25% of the cases with a serious renal injury. [7] Although N-acetyl-β-D glucosaminidase (NAG; 2-acetamidodeoxy-β-glucoside acetamidodeoxy glucohydrolase) has been used for the identification of renal diseases and injuries, its application in renal traumas remains an unknown issue.…”

Section: Resultsmentioning

confidence: 99%

Determination of urinary N-acetyl-β-D glucosaminidase (NAG) levels in experimental blunt renal trauma

Hanbeyoğlu¹,

Kazez²,

Üstündağ³

et al. 2011

Ulus Travma Acil Cerrahi Derg

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AMAÇİdrar N-asetil-β-D glukozaminidaz (NAG) düzeyinin, künt böbrek yaralanmasının tanı ve takibinde kullanılabilirliği araştırıldı. GEREÇ VE YÖNTEMYirmi adet Sprague-Dawley cinsi genç-erişkin sıçanla ça-lışıldı. Sham grubunda sol böbrek eksplorasyonu yapıl-dı. Travma grubunda sol böbrek eksplore edildikten sonra 20 gr ağırlık böbrek üzerine düşürüldü. İşlem öncesi, iş-lem sonrası 0-6., 12-24., 24-36. ve 36-48. saatler arasında strip ile idrar tetkiki, idrar NAG ve kreatinin (Cr) düzeyle-ri için örnekler alındı. İstatistiksel analiz Mann-Whitney U ve Kruskall Wallis testleri ile yapıldı. BULGULARTravma oluşturulan böbreklerin makroskopik incelemelerinde grade II ve III yaralanma olduğu, histopatolojik incelemelerinde de beklenen patolojik değişiklikler görül-dü. Travma grubundaki sıçanların hepsinde makroskopik hematüri izlendi. Travma grubunda 0-6., 12-24., 24-36. ve 36-48. saatler arasındaki idrar NAG/Cr düzeyleri işlem öncesi kontrol değerlere göre anlamlı olarak yüksek bulundu. Sham grubunda ise sadece 0-6. saatteki idrar NAG/ Cr düzeyleri kontrol değerlere göre anlamlı olarak yük-sekti. Sıfır-6. saatteki NAG/Cr düzeylerindeki artış travma grubunda anlamlı olarak daha fazlaydı. SONUÇİzole künt böbrek yaralanmalarından sonra erken dönemde idrar NAG düzeyleri anlamlı olarak yükselmektedir. NAG düzeylerinin künt böbrek yaralanmalarında bir ölçüt olarak kullanılabilirliği için daha kapsamlı ve klinik çalışmalarla geliştirilmesi gerekmektedir.

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Management of Blunt Renal Trauma

Cited by 58 publications

References 21 publications

Blunt renal trauma in children with previously undiagnosed pre‐existing renal lesions and guidelines for effective initial management of kidney injury

Blunt renal trauma in children with previously undiagnosed pre‐existing renal lesions and guidelines for effective initial management of kidney injury

Manejo conservador de los traumatismos renales de alto grado

Determination of urinary N-acetyl-β-D glucosaminidase (NAG) levels in experimental blunt renal trauma

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