Renal trauma

　　Renal trauma can be divided into open and closed injuries. The former is more common in wartime, due to firearm贯通 wounds or blade injuries, while in peacetime, it is more common to have stab wounds, often with injuries to chest and abdominal organs. The latter is more common in peacetime, and the causes of injury are divided into direct violence and indirect violence.

　　1. Direct violence

　　Impact or compression on the lower back or upper abdomen can cause renal injury. Force from behind or in front can cause the ribs to suddenly move forward or the kidney to move backward, causing injury to the kidney. This is most common in traffic accidents, soil collapse, or falling from a height with the lower abdomen impacting a hard object, which is the most common cause.

　　2. Indirect violence

　　High-altitude falls, where the feet or buttocks land, or sudden braking that produces decelerative injuries, this indirect violence can cause avulsion of the renal pedicle or rupture at the renal pelvis-ureteral junction. The powerful contraction of the lumbar muscles can also cause contusion of the kidney, resulting in hematuria. The kidney (congenital or acquired organic disease) with pathological changes can also be damaged by slight external force, often referred to as spontaneous renal rupture.

　　Early complications after renal trauma include secondary hemorrhage, renal and perirenal infection, and the formation of urinary fistulas. Late complications include hydronephrosis, pyelonephritis, hypertension, renal calculi, urinary cysts, renal arteriovenous fistulas, and non-functioning kidneys, among others.

　　Both open and closed renal injuries may be accompanied by injury to thoracic, abdominal organs, spine, or distant tissues. Clinically, their symptoms and signs often overlap, and attention should be paid during diagnosis to avoid misdiagnosis.

　　The severity of symptoms of renal trauma varies, depending on the strength of the external force and the degree of renal parenchymal injury. Below, I will give a detailed introduction to this:

　　1. Shock

　　It can lead to shock due to trauma and/or bleeding, especially when combined injuries occur, particularly when abdominal solid organs are damaged. Therefore, it is very important to closely monitor vital signs during treatment.

　　2. Hematuria

　　It is the most common and important symptom of renal trauma, with gross hematuria being most common. It is noteworthy that the degree of hematuria does not necessarily correspond to the severity of the trauma, so clinically, it is not possible to judge the severity of the injury based on the amount of blood in the urine. Hematuria usually disappears within a few days, but if activity is resumed too soon after the injury or if an infection occurs, secondary hemorrhage may occur.

　　3. Local mass

　　Blood and urine extravasation into the perirenal tissue can be palpated as a mass deep in the upper abdomen. It should be observed for any further enlargement. If local pain worsens with fever and an increase in blood leukocytes, it is indicative of perirenal infection.

　　4, Pain and muscle tension

　　Soft tissue injury at the injury site, renal parenchymal injury, and irritation of the renal capsule can all cause pain in the lumbar or upper abdomen. Blood clots blocking the ureter can also cause colic. The渗入腹腔的血液和尿液 can cause typical peritoneal irritation symptoms, and the site of pain may have muscle tension and tenderness.

　　5, Symptoms of associated injuries

　　Both open and closed renal injuries may be accompanied by injury to thoracic, abdominal organs, spine, or distant tissues. Clinically, their symptoms and signs often overlap, and attention should be paid during diagnosis to avoid misdiagnosis.

　　6, Open renal injury

　　According to the location and direction of the wound channel and the leakage of urine, it is speculated whether there is renal trauma, but the wound does not necessarily have a large amount of bleeding or leakage. Since such traumas are often accompanied by other injuries, early surgical exploration should be performed.

　　Renal trauma is caused by direct trauma to the abdomen, such as kicks, falls, or direct injury. Therefore, attention should be paid to living habits, high-risk workers such as construction workers, miners, and truck drivers are prone to injury due to accidents, and they should pay attention to protecting themselves during work. Be calm when facing things, avoid emotional excitement leading to conflict and causing the disease. Secondly, early discovery, early diagnosis, and early treatment are also of great significance for the prevention of the disease.

　　Renal trauma is more common in sharp instrument injuries or violent injuries, and it can be diagnosed by auxiliary examinations such as ultrasound, X-ray, and CT.

　　(1) Urine

　　Hematuria is an important basis, so urine examination is extremely important. If urination cannot be performed spontaneously, cystoscopy should be performed.

　　(2) X-ray examination

　　Abdominal flat film: There are generally no abnormalities in renal contusion, and renal laceration can show an enlarged or blurred renal shadow, disappearance of the lumbar psoas shadow, the spine convex to the healthy side, or there may be fractures, etc. If it is a gunshot wound, metal debris may be visible.

　　Excretory urography: It should be performed under the condition of injury, generally requiring double or large doses of contrast agent to obtain ideal results. This method not only can understand the condition of the injured kidney but also can check the existence and function of the contralateral kidney. When there is renal contusion, the renal pelvis and calyces show normal, and the calyces may be slightly displaced due to subcapsular hematoma. When there is renal laceration, part of the calyces may show delayed imaging, and the area where the contrast agent leaks out is the location of the renal parenchymal laceration. When there is crush injury, the renal pelvis and calyces often do not show clear shadows or there are multiple leaks of contrast agent.

　　Renal arteriography: It is not considered a routine examination and is only performed when renal pelvis造影 fails and the diagnosis cannot be clarified, especially it is of great significance for the diagnosis of vascular injury.

　　Retrograde pyelography: This method has diagnostic value for traumatic injury of the collecting system, and as a supplementary examination, due to the risk of infection and certain pain, it is rarely used in clinical practice.

　　(3) Radionuclide renal scan

　　During contusion, the scan image shows normal, while laceration shows irregular renal outline, the hematoma area appears as a radioactive cold area, which can be used as a supplementary examination.

　　(4) B-ultrasound and CT examination

　　All can be checked for the location and range of the renal parenchyma and hematoma.

　　If the symptoms of patients with renal trauma are mild or in the recovery period, dietary adjustments can help patients recover quickly. So what should be paid attention to in the diet of patients with renal trauma?

　　The diet of renal trauma patients should be selected with high-quality low-protein, high-vitamin, low-salt, and low-potassium foods. High-quality protein diet such as eggs, fish, lean meat, and milk, should eat less plant protein-rich foods such as peanuts and their products, as they contain more non-essential amino acids. To limit the intake of plant protein, it can be partially used as staple food, replacing rice and flour. Pay close attention to malnutrition when restricting protein intake. The determination of blood albumin, albumin precursor, and transferrin is a simple monitoring index. Eating vegetables such as chives, scallion whites (raw), tofu, walnuts, peanuts, and oysters is good for the kidneys.

　　Patients with renal trauma should avoid eating salt, soy sauce, and foods high in potassium, such as bananas, tangerines, jujubes, peanuts, apricots, seaweed, kelp, dairy products, etc., and avoid spicy and irritant foods.

　　Renal trauma is generally not easy to be injured, and renal trauma is more common in young and middle-aged males, which is related to factors such as occupation and physical activity. So how to treat renal trauma?

　　(1) Treatment Principles for Closed Injuries

　　1. Renal contusion and superficial laceration: non-surgical treatment is generally adopted.

　　(1) Absolute bed rest for at least 14 days.

　　(2) Necessary intravenous fluid or blood transfusion.

　　(3) Analgesics and hemostatics.

　　(4) Antibiotics to prevent infection.

　　(5) Close observation of changes in the condition, vital signs, hemoglobin, hematocrit, blood volume in urine, and changes in the size of abdominal masses.

　　2. In cases of severe renal laceration or comminuted injury and fracture of the collecting system with a large amount of urinary extravasation, surgical treatment should be adopted.

　　(2) Treatment of Open Wounds

　　After the general condition of the injured person improves, surgical treatment is adopted to explore the renal and other organ injuries, and appropriate treatment is given. Postoperative wound drainage.

　　(3) Surgical Method

　　Exploration of closed renal trauma should be performed through an abdominal incision to be able to explore whether there is concomitant injury to abdominal organs and to explore the condition of the contralateral kidney. Before exploring the injured kidney, the renal blood flow should be blocked to reduce blood loss, which can also reduce the rate of nephrectomy.

　　(4) Renal Artery Embolization

　　Selective renal artery embolization has been gradually applied in recent years for renal traumatic hemorrhage, especially for cases with solitary kidney injury that is not suitable for surgical treatment, and has the effect of preserving the residual kidney function.