Traumatic kidney rupture in hydronephrosis

Abstract

The hydrostatic pressure, intrapelvic volume, and specific elasticity and strength of strips of tissue from the parenchyma and the pelvis of eight hydronephrotic kidneys were investigated and compared with the tissue characteristics of the pelvis of four control kidneys. Hydronephorsis manifested itself by a sixfold reduction of tissue strength, and dynamically by a ninefold reduction of the energy absorptive capacity of the parenchyma as compared with the pelvis. Its further response to trauma appeared to be influenced by internal pressure, the law of mass variation, and the energy absorptive capacity of surrounding anatomical structures. The vulnerability of the hydronephrotic kidney in situ depends on its volume and topography, the parenchyma being the part that may be regarded as the site most predisposed to rupture.

Evaluation and management of renal injuries: consensus statement of the renal trauma subcommittee

“…The preponderance of evidence suggests that pre‐existing renal lesions increase the vulnerability of kidneys in blunt renal trauma [49–58]. There have been four studies reviewing 733 adult and paediatric patients with renal abnormalities and trauma [51,53,57,58].…”

“…In all cases patients were unaware of the underlying disorder at the time of the accident. The cause of the predisposition has been attributed to reduced tissue strength in hydronephrotic kidneys, altered tissue deformation of renal cortex in the presence of a fluid‐filled lesion (cyst, hydronephrosis), the relatively larger body proportion of paediatric kidneys, and their lesser protection from the more pliable thoracic cage, weaker abdominal musculature and less perirenal fat [56,58].…”

Blunt Renal Trauma in a Pre-Existing Renal Lesion

“…This predisposition has been attributed to decreased tissue strength in hydronephrotic kidneys and an altered tissue deformation of the renal cortex in the presence of a fluidfilled lesion (cyst, hydronephrosis). Increased susceptibility in the pediatric population can be explained by the relatively larger body proportion of pediatric kidneys and their lesser protection from the more pliable thoracic cage, weaker abdominal musculature, and less perirenal fat [2,5]. In BRT, the decision to image should be based on history, mechanism of injury, physical findings, laboratory studies, and clinical status.…”