Emergency Central is a collection of disease, drug, and test information including 5-Minute Emergency Medicine Consult, Davis’s Drug, McGraw-Hill Medical’s Diagnosaurus®, Pocket Guide to Diagnostic Tests, and MEDLINE Journals created for emergency medicine professionals. Explore these free sample topics:
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- Kidneys are located in the retroperitoneal space and are surrounded by adipose tissue and loose areolar connective tissue.
- Kidneys lie along the lower 2 thoracic vertebrae and 1st 4 lumbar vertebrae.
- Left kidney is positioned slightly higher than the right.
- Kidneys are not fixed:
- Shift with the diaphragm and are supported by the renal arteries, veins, and adipose tissue to the renal (Gerota) fascia
- Most common of all urologic injuries
- Occurs in ∼8–10% of all abdominal trauma
- Blunt renal trauma accounts for 80–85% of all renal injuries and is 5 times more common than penetrating injury:
- Mechanisms include motor vehicle accidents, falls, domestic violence, and contact sports.
- Pathophysiology includes rapid deceleration and displacement mechanisms.
- ∼20% of cases are associated with intraperitoneal injury.
- Mechanisms responsible for significant renal injury almost never affect the kidney alone:
- Most often disrupt and injure other vital organs that can be responsible for patient mortality
- Renal injuries are graded by type and severity of injury (Association for the Surgery of Trauma [AAST] criteria)
- Grade I
- Contusion: Microscopic or gross hematuria, urologic studies normal
- Hematoma: Subcapsular, nonexpanding without parenchymal laceration
- Grade II:
- Hematoma: Nonexpanding, perirenal hematoma confined to retroperitoneum
- Laceration: <1 cm parenchymal depth of renal cortex without urinary extravasation
- Grade III
- Laceration: >1 cm parenchymal depth of renal cortex without collecting system rupture or urinary extravasation
- Grade IV:
- Laceration: Parenchymal laceration extending through renal cortex, medulla, and collecting system
- Vascular: Main renal artery or vein injury with contained hemorrhage
- Grade V:
- Laceration: Completely shattered kidney
- Vascular: Avulsion of renal hilum, devascularizing the kidney
- Grade I
- The kidney is the organ most commonly damaged by blunt abdominal trauma.
- Contributing factors:
- Relatively larger size of kidneys compared with adults
- 10th and 11th ribs are not completely ossified until the 3rd decade of life.
- Significant abdominal injury occurs in about 5% of nonaccidental trauma cases but is the 2nd most common cause of death after head injury.