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Pedi gu review renal trauma
1. Renal Trauma Pediatric GU Review UCSD Pediatric Urology George Chiang MD Sara Marietti MD Outlined from The Kelalis-King-Belman Textbook of Clinical Pediatric Urology 2007 (not for reproduction, distribution, or sale without consent)
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8. American Association for the Surgery of Trauma Organ Injury Severity Scale for the Kidney Moore, Shackford, J Trauma, 1989 Grade Description of Renal Injury I Contusion : hematuria with normal radiological studies. Hematoma : subcapsular and non expanding. II Hematoma : perirenal ,confined to retroperitoneum. Laceration : < 1 cm depth without extravasation III Laceration : > 1cm depth without collecting system injury or extravasation. IV Laceration : through renal cortex, medulla, collecting system. Vascular : renal artery or vein injury : contained hemaorrhage. V Laceration : shattered destroyed kidney Vascular : renal arterial and venous avulsion.
Pathophysiologically, shearing forces exceed the tensile strength of renal parenchyma Handguns are low velocity of <1000 ft/s and assault rifles are considered high velocity of >1000 ft/s Blast effect from a projectile may cause delayed tissue necrosis, leading to bleeding, urine leak, or abcess
Pathophysiologically, shearing forces exceed the tensile strength of renal parenchyma Handguns are low velocity of <1000 ft/s and assault rifles are considered high velocity of >1000 ft/s Blast effect from a projectile may cause delayed tissue necrosis, leading to bleeding, urine leak, or abcess
Unclear if children have increased risk of renal injury after blunt trauma. Classically, hydronephrotic kidneys were thought to be more prone to injury from trauma.
1. A significant deceleration or high-velocity injury such as one sustained in a high-speed motor vehicle accident, a pedestrian/bicycle-motor vehicle accident, a fall from more than 15 feet, or a strike to the abdomen or flank with a foreign object (e.g., football helmet, baseball bat) 2. Significant trauma that has resulted in fractures of thoracic rib cage, spine, pelvis, or femur, or bruising of the torso/perineum, or signs of peritonitis 3. Gross hematuria 4. Microscopic hematuria (<50 red blood cells per high-powered field) associated with shock (systolic blood pressure less than 90 mm Hg)
Two heterogeneous renal masses were discovered in which the diagnosis of a malignant process could not be eliminated; elective resection and open biopsy were performed. The diagnoses of multicystic kidney and solitary cyst with complex hematoma, respectively, were confirmed on pathology. Grade III ureterovesical reflux with pyelonephritis (n = 1), polycystic kidney (n = 1), extrarenal pelvis without obstruction (n = 1), and horseshoe kidney (n = 1) were the other lesions
World J Surg. 2001 Dec;25(12):1557-60 Radiologic evaluation of pediatric blunt renal trauma in patients with microscopic hematuria. Brown SL , Haas C , Dinchman KH , Elder JS , Spirnak JP .Department of Urology, Rainbow Babies and Children's Hospital, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio 44106, USA. sbrown2200@home.com
