Kidney Injury

　　Renal injury is divided into two types: closed injury and open injury, which can be caused by the following reasons.

　　1. Closed renal injury includes direct violence, indirect violence, muscle strong contraction, and iatrogenic reasons. Direct violence refers to injury to the renal area caused by direct force, such as in traffic accidents, beating injuries, or when the renal area hits hard objects during falls, which is the most common cause of renal injury. Indirect violence is more common in fall injuries, where the kidneys are subjected to severe vibration upon landing on the feet or buttocks. Under pathological conditions such as hydronephrosis, renal cysts, calculi, or tumors, heavy lifting, strenuous exercise, or sudden and violent body movements can cause muscle strong contraction, leading to spontaneous renal rupture. Since the development of extracorporeal shock wave lithotripsy (ESWL) and endourological surgery, inappropriate operations such as blindly increasing voltage or increasing the number of shock waves during lithotripsy, inserting ureteral catheters too deeply, or injecting excessive contrast medium during retrograde pyelography can cause iatrogenic renal injury.

　　2. Open renal injury is caused by penetrating injuries from knives, guns, or shrapnel, often accompanied by injuries to other abdominal and thoracic organs.

　　Complications after renal injury are divided into early and late types. So-called early complications refer to those that occur within 6 weeks after injury, which threaten the patient's life or cause the injured kidney to fail, such as secondary hemorrhage, urinary extravasation, perinephric abscess, acute tubular necrosis, urinary fistula, and so on. Late complications include hypertension, hydronephrosis, calculi, chronic pyelonephritis, chronic renal insufficiency, arteriovenous fistula, and so on. These two types of complications mostly occur after severe renal injury, with some exceptions. In addition, for acute renal injury, which is often of critical onset and attracts high attention, common complications include: (1) Infection: respiratory, urinary, and gastrointestinal tract infections; (2) High-volume overload: pulmonary edema, heart failure, malignant hypertension, and so on; (3) Hyperkalemia, metabolic acidosis, and other electrolyte imbalances as well as arrhythmias; (4) Multi-organ dysfunction; (5) Gastrointestinal bleeding.

　　For the above complications, the current clinical treatment methods commonly used include the following: (1) Retroperitoneal urinoscopy or perinephric abscess - incision and drainage. (2) Ureteral stenosis, hydronephrosis - plastic surgery or nephrectomy. (3) Malignant hypertension - vascular repair or nephrectomy. (4) Arteriovenous fistula and pseudo-renal artery aneurysm - repair, and if it is within the renal parenchyma, partial nephrectomy can be performed. (5) Persistent hematuria - selective renal artery angiography and embolization.

　　The main symptoms of kidney injury are shock, bleeding, hematuria, lumbar pain, mass, and abdominal wall rigidity on the injured side.

　　(One) Shock

　　Kidney injury often presents with shock symptoms, accounting for 30% to 50%. Severe kidney injuries often have varying degrees of shock. The degree of shock is often related to the speed of bleeding, the time of visit, the severity of associated injuries, and the body's compensatory capacity. Severe kidney injuries often accompany shock and require close observation and treatment to prevent recurrent shock, which indicates recurrent bleeding.

　　(Two) Bleeding

　　The amount of bleeding varies. Secondary bleeding may occur several weeks after the injury and should be vigilant.

　　(Three) Hematuria

　　Hematuria is the most common symptom of most kidney injuries, including gross or microscopic hematuria. If the renal pedicle or ureter is completely ruptured or the ureter is blocked by blood clots or kidney fragments, there may be no hematuria. Generally speaking, the amount of hematuria is consistent with the severity of the injury, but sometimes less hematuria does not necessarily mean a mild kidney injury, because some severe kidney lacerations do not cause blood to flow from the renal pelvis and ureter, and blood clots blocking the ureter can also cause sudden cessation of hematuria.

　　(Four) Lumbar pain

　　Pain can be localized to the lumbar region, upper abdomen, can spread to the entire abdomen, or radiate to the shoulder, hip, and lumbosacral region.

　　(Five) Mass

　　Due to the extrusion of blood and urine during kidney rupture, irregular diffuse masses may appear in the lumbar region.

　　(Six) Abdominal wall rigidity

　　There is significant muscle spasm and tenderness in the lumbar region of the injured side, and these symptoms are more pronounced when there is urine leakage.

　　In medical practice, the variety and frequency of use of drugs such as antibiotics and immunosuppressants are increasing, as are various imaging examinations, chemotherapy, radiotherapy, and interventional treatments. This has led to an increase in the burden on the kidneys and the likelihood of damage, resulting in a significant rise in the incidence of acute kidney injury. We should prevent the occurrence of acute kidney injury from the following aspects:

　　Rational drug use should be practiced to avoid using drugs that may cause acute kidney injury, such as cantharidin, tripterygium, andrographis, sowerberry, lead丹, cinnabar, realgar, and others. This is especially true for patients with pre-existing kidney conditions.

　　Strictly control the dosage of drugs, it should be pointed out that the dosage of traditional Chinese medicine is mostly based on traditional experience, and the effective dose, maximum tolerated dose, minimum lethal dose, safe range, and therapeutic index are not fully clear. Many drugs recorded as non-toxic in the literature of past materia medica can also cause toxic reactions.

　　Pay attention to individual differences in physical constitution, age, gender, and race, and adjust the dosage appropriately.

　　During medication, close attention should be paid to the detection of kidney function damage, such as changes in urine routine, urine enzymes, and renal function, in order to achieve early diagnosis. Once acute kidney injury is found, medication should be discontinued promptly to remove the cause, and for mild reactions, medication should be discontinued promptly and comprehensive treatment measures, kidney protection, and supportive therapy should be adopted, which may stop the progression of kidney injury and tend towards recovery. Early renal replacement therapy can be performed if acute renal failure occurs.

　　Laboratory tests:

　　For patients with lumbar and abdominal injuries and suspected kidney injury, an immediate urinalysis should be performed to understand the bleeding condition. If necessary, catheterization should be performed to collect urine for color observation. However, the amount of hematuria is not always proportional to the extent of injury.

　　Other auxiliary examinations:

　　1.CT - It is of great importance in the diagnosis and follow-up of kidney injury. It should be used as the first choice of examination when the patient's overall condition permits. It can not only accurately understand the extent and range of renal parenchymal injury, as well as the condition of blood and urinary extravasation, but can also clarify whether there is any injury to other abdominal organs at the same time.

　　2. Ultrasound - Can preliminarily understand the extent of kidney injury and the condition of perirenal hematoma and urinary extravasation.

　　3.X-ray examination - According to the leakage of contrast agent during excretory urography, the extent and range of kidney injury can be understood, as well as the condition of renal function on both sides. When excretory urography does not show any shadow and there is suspicion of renal pedicle vascular injury, renal arteriography can be performed, but it should be carried out when the condition is stable. Renal arteriography can detect contrast agent leakage and blockage of larger renal blood vessel branches. After renal arteriography is confirmed, selective renal artery branch embolization can be performed to control bleeding.

　　For healthy individuals, hyperlipidemia does not directly cause kidney disease, but for patients with kidney disease, if the level of low-density lipoprotein cholesterol in the blood increases, it will bind specifically to the cell membrane system in the kidneys, causing proliferation of the cell membrane system, promoting glomerular sclerosis, aggravating the condition, and诱发 kidney failure, posing a threat to life.

　　Most patients with kidney disease, if they do not watch their diet and overindulge in rich and sweet foods, can cause hyperlipidemia in the plasma, leading to glomerular enlargement, partial glomerular sclerosis, and kidney tissue damage. This damage is proportional to the increase in blood lipids, meaning the higher the blood lipids, the greater the damage.

　　For patients with kidney disease, there are restrictions on the intake of salt, protein, and water. It is also necessary to limit the intake of cholesterol-rich foods. Generally, the daily intake of cholesterol for healthy adults should be less than 300 milligrams, and for those with hypercholesterolemia, especially those with chronic kidney disease, it is advisable not to exceed 200 milligrams.

　　For patients with chronic kidney disease, it is recommended to arrange the intake of soybean oil, sesame oil, eat more fiber and vitamin C-rich foods, such as coarse grains, vegetables and fruits, to increase the excretion of cholesterol from feces. Boil traditional Chinese medicine tea every day: hawthorn 15 grams, alisma 15 grams, which has a therapeutic effect on hyperlipidemia.

　　In addition, if kidney injury patients have a large amount of proteinuria and obvious edema, attention should be paid to the appropriate intake of high-quality protein in diet, such as lean meat, fish, etc. Do not eat preserved food, and eat light food. Do not eat spicy and irritating food, do not eat seafood and other food that is easy to cause allergies. Avoid using nephrotoxic drugs.

　　(I) Conservative Treatment The kidney has a strong repair capacity, and most kidney injury patients, such as contusion or partial laceration, can be cured by non-surgical treatment. These treatments include: ① Resuscitation of shock, including fluid infusion, blood transfusion, and analgesia; ② Absolute bed rest for at least 2-3 weeks, avoid physical activities and labor for 2-3 months after getting out of bed, in order to prevent secondary hemorrhage; ③ Antibacterial treatment to control infection. During the implementation of supportive therapy, it is necessary to closely observe changes in blood pressure, pulse, hematuria, hemoglobin, etc.

　　(II) Surgical Treatment During the conservative treatment process, the condition gradually worsens, such as the gradual enlargement of lumbar hematoma, recurrent massive hematuria, severe shock without improvement after fluid resuscitation and blood transfusion, obvious extrarenal urination, severe local infection, or associated with abdominal organ injury, surgical treatment is required. Before surgery, it is necessary to understand the condition of the contralateral kidney through intravenous pyelography and radioactive isotope examination. The choice of renal surgical method is mainly determined by the degree of kidney injury.

　　Selective renal artery embolization: The main indications should be severe renal contusion and laceration. For some patients who need emergency nephrectomy, embolization can temporarily stop bleeding to control shock, so that the patient can tolerate surgery.

　　Renal area drainage: It is suitable for renal贯通伤, severe extrarenal urination, or formation of perinephric infection.

　　Kidney repair or partial nephrectomy: If the kidney is partially ruptured, at one or more places, and the renal pelvis and ureter are intact, and there is no obvious extrarenal urination or infection, kidney suture should be adopted as much as possible.

　　Nephrectomy: Nephrectomy should be performed for severe kidney injury that cannot be repaired or for uncontrollable bleeding.