Evidencebased recommendations for the diagnosis and management of renal trauma were made with reference to a. Aast kidney injury scale radiology reference article. Current management of highgrade blunt renal trauma favors a nonoperative approach when possible. Sibaja herrera summary in costa rica, according to the world health organization oms one trauma dead is reported in 2004 of 54 of each. American association for the surgery of trauma grade 4 renal injury substratification into grades 4a low risk and 4b high risk. We present a revision of the renal trauma with emphasis in the radiographic evaluation, particularly ct scan that it has largely replaced the excretory urogram and arteriogram in the diagnostic worhup and management of the patient with renal trauma. Hematuria as a predictor of abdominal injury after blunt trauma. Citations 0 references 28 researchgate has not been able to resolve any citations for this publication. Shattered kidney, thrombosis of renal artery, avulsion of hilum. Blunt trauma damage caused by impact from an object that doesnt break the skin. The leading cause of death in children is accidents. Insuficiencia renal cronica irc en pediatria, fisiopatologia.
Conservative management has been increasingly applied to patients with renal trauma due to the success this option has seen in handling other solid organ injuries. The kidney is considered to be the most commonly damaged organ of the urinary system with the male to female ratio being 3. The lions share of renal trauma patients are managed nonoperatively with careful monitoring, reimaging when there is any deterioration, and the use of. Urologic trauma is defined as injury to the kidneys, ureters, bladder, urethra, or external genitalia as a result of external force. Successful nonoperative management of highgrade blunt. Now customize the name of a clipboard to store your clips. Urotrauma guideline american urological association. The incidence of renal trauma somewhat depends on the patient population being considered.
Patient selection is the preliminary step in adopting a nonoperative management strategy to renal trauma. Clipping is a handy way to collect important slides you want to go back to later. Jan 01, 2019 in the setting of blunt renal trauma and selected instances of penetrating renal trauma, a nonoperative approach may be selected. In the management of renal trauma, surgical exploration typically leads to nephrectomy in all but a few specialized centers. Radiographic assessment of renal trauma, the journal of urology, pp. Tc e indicata in traumi chiusi in una delle seguenti. The lions share of renal trauma patients are managed nonoperatively with careful monitoring, reimaging when there is any deterioration, and the use of minimally invasive procedures. Blunt renal trauma and the predictors of failure of nonoperative management.
Oct 01, 2001 renal imaging is generally unnecessary if the patient is normotensive and has only microscopic hematuria, because the risk of serious injury that needs operative management is less than 0. Provide guidelines for the management of renal contusions, renal fractures, renal vascular injuries and bladder perforations. Trauma abdominal cerrado y penetrante con lesion a organos. In children, blunt trauma is responsible for 90% of renal injuries, and the kidney is injured in approximately 10% of all pediatric blunt abdominal trauma. A parenchymal defect of the kidney associated with hematoma or urinoma.
Blunt kidney trauma bkt occurs more often than penetrating trauma, being 9 times more common. The renal trauma can be life threatening in the short term, depending on the severity and the time between the onset. The eau urological trauma guidelines panel consists of an international group of clinicians with particular expertise in this area, the panel includes urologists and an interventional radiologist. Ct is the preferred method of investigation in the setting of acute renal trauma. The englishlanguage literature about renal trauma was identi. Contemporary evaluation and management of renal trauma a male predominance of 3. Contemporary evaluation and management of renal trauma. Traumatismos renales lesiones y envenenamientos manual. Revision of current american association for the surgery of trauma renal injury grading system. Nearly half of childhood death between the ages of 114 in the united states can be attributed to traumatic incidents. Since 2001, 18 cases of paediatric renal trauma have been diag.
This difference has been attributed to the involvement of men in highrisk activities. Defects in perfusion of the kidney on ct or ivp that is consistent with a parenchymal contusion. Non operative management of renal injuries with renal salvage as the primary. The american association for the surgery of trauma aast renal injury scale, most recently updated in 2018, is the most widely used grading system for renal trauma the 2018 update incorporates vascular injury i. Blunt renal trauma in children with previously undiagnosed preexisting renal lesions and guidelines for effective initial management of kidney injury. Trauma abdominal cerrado y penetrante con lesion a organos abdominales blunt and penetrating abdominal trauma with injury to intraabdominal organs karla lisseth leonher ruezga, jose alfredo jimenez gomez, luis ricardo ramirez gonzalez, mario sandoval santa cruz, juan jesus gil vigna, ilse maria tello barba. The kidney is the most common genitourinary organ injured from external trauma, occurring in 1% to 5% of all injuries. Of injuries in general, renal trauma represent about 1% 5% of cases, and the kidney is the genitourinary and abdominal organ injured more often. In general, blunt injuries are more common, accounting for up to 90%95% of renal injuries. Renal trauma may manifest in a dramatic fashion for both the patient and the clinician.
Timothy evans, md, facep associate professor, department of emergency medicine, virginia commonwealth universitymedical college of virginia hospitals and christine murphy, md, resident iii, department of emergency medicine, virginia commonwealth universitymedical college of virginia hospitals in. The urological trauma guidelines were first published in 2003. Outline of a diagnostictherapeutic protocol consistent with the literature. Renal trauma management has evolved during the last decades, with a distinct evolution toward a nonoperative approach. But injuries can happen as a result of blunt trauma or penetrating trauma. Your kidneys are guarded by your back muscles and rib cage. Experience of renal artery embolization in patients with.
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