ruptured kidney
Introduction
Introduction Renal rupture refers to rupture of the kidney in the event of injury or non-injury, including rupture of the renal parenchyma, renal pelvis and renal blood vessels, often secondary to pathological kidneys, which is relatively rare in clinical practice. The kidneys are deep in the kidney socket and are well protected by the surrounding structure: there are long muscles of the ribs, spine and back in the back of the kidney, the abdominal wall and the contents of the abdomen in front, and the upper part is covered by the diaphragm. Normal kidneys have an activity of 1 to 2 cm, so the kidneys are not easily damaged. However, on the other hand, the posterior bone structure can also cause kidney damage. The broken end of the rib fracture can penetrate into the renal parenchyma; the kidney is squeezed between the spine and its transverse process and damaged.
Cause
Cause
Kidney damage is divided into two types, closed injury and open injury, which can be caused by the following reasons:
Closed kidney injury
These include direct violence, indirect violence, strong muscle contraction, and iatrogenic reasons.
Direct violence is caused by direct violence in the kidney area. It is the most common cause of kidney damage caused by a car accident, a blow injury or a kidney hitting a hard object.
Indirect violence is more common in fall injuries, caused by severe vibrations of the kidneys when the feet or hips touch the ground. In pathological conditions such as hydronephrosis, renal cysts, stones or tumors, such as carrying heavy objects, strenuous exercise or sudden and vigorous rotation of the body, causing strong muscle contraction, can cause spontaneous renal rupture. Since the onset of extracorporeal shock wave lithotripsy (ESWL) and endoscopic urology, iatrogenicity can be caused by improperly increasing the voltage or increasing the number of bombardments, deep insertion of the ureteral catheter, and injection of excess contrast agent into the renal pelvis retrograde angiography. Kidney damage.
2. Open kidney injury
Because the knife and the gun shrapnel penetrate the wound, it often combines the damage of other organs in the chest and abdomen.
Examine
an examination
Related inspection
Renal angiography, renal ultrasound, urine routine
1. Hematuria: gross damage can occur in gross hematuria, mild injury is microscopic hematuria, if the ureter, renal pelvis is broken or the renal pedicle is broken, there is no hematuria.
2. Shock: Severe kidney damage, especially when combined with other organ damage. Tables present with traumatic shock and hemorrhagic shock are even life-threatening.
3. Pain and abdominal mass: Pain caused by local soft tissue injury or fracture can also be caused by increased renal capsule tension; sometimes it can cause renal colic due to obstruction of ureteral clot. When the perihematomal hematoma and extravasation of the urine are formed, local swelling occurs to form a mass.
4. High fever: due to blood and urine extravasation caused by perirenal infection.
5. Wound bleeding: a healthy search when a knife or a penetrating injury affects the kidney, and the wound can flow a lot of blood. The amount of bleeding is related to the degree of kidney damage and whether there are injuries to other organs or blood vessels.
According to the clinical manifestations of the injury history and urine examination, a preliminary diagnosis of kidney injury can be made. Hematuria is one of the important basis for diagnosing kidney injury. For those who cannot urinate on their own, catheterization should be performed. KUB and IVU can understand fractures, renal parenchymal rupture and peri-renal hematoma. B-ultrasound can initially understand the damage of renal parenchyma. CT is a non-invasive examination, which can accurately understand the renal parenchymal injury and blood and urine extravasation. It can find a combined injury in time. When typical peritoneal irritation or mobile dullness occurs in renal injury, the possibility of intra-abdominal organ damage should be guarded. Abdominal puncture has a certain diagnostic value. Early diagnosis and effective and reasonable rescue measures can win time for surgery and lay the foundation for patient recovery.
Diagnosis
Differential diagnosis
1. Abdominal organ damage: mainly liver and spleen injuries can sometimes occur simultaneously with kidney damage. It is characterized by acute symptoms such as hemorrhagic shock and obvious symptoms of peritoneal irritation. Abdominal puncture can be taken by hemorrhagic liquid urine without red blood cells; ultrasound examination of no abnormalities in the kidney; IVU showed normal renal pelvis and renal pelvis, no contrast agent spillover.
2. Renal infarction: manifested as sudden low back pain, hematuria, elevated blood pressure; VU showed slow or no development of kidney development. Retrograde pyelography can be found in the subcapsular hematoma. Patients with renal infarction often have a history of cardiovascular disease or renal arteriosclerosis, elevated serum lactate dehydrogenase, glutamate oxaloacetate transaminase and alkaline phosphatase.
3. Spontaneous renal rupture: sudden onset of low back pain and hematuria. Physical examination showed obvious tenderness and muscle tension in the waist and abdomen, and it could touch the cystic mass with unclear margin. IVU examination showed renal pelvis and renal pelvis deformation and contrast agent spillover. B-ultrasound showed a disorder of the renal collecting system, and there was a liquid dark area around the kidney. Generally, there is no obvious history of trauma, and there are many cases of kidney tumor, kidney tuberculosis, and hydronephrosis.
