Internal organs are quite well protected from mechanical damage. However, injuries are possible here. Contusion of the kidney is not the most common phenomenon and, as a rule, is associated with injuries of other pelvic organs.
Kidney injury
Ribs and spine, back muscles, fatty subcutaneous layer, paranephric fiber - all this creates a reliable barrier to mechanical factors. However, injuries, nevertheless, are possible.
According to its characteristics, the injury belongs to the category of closed injuries along with crushing, rupture of the fibrous membrane, concussion and so on.
There are 2 types of lesions:
- isolated trauma - only the right or left kidney is bruised, the patient enters the urological department;
- combined - several different organs are damaged. Victims are more likely to be in the surgical department.
The organ contusion causes a short-term positive pressure above 1000 atm., Or a low negative pressure of 50 atm.
Two factors can ensure this impact:
- direct injury - drop on solid object, shock, lumbar injury, squeezing;
- indirect impact - falling from a height, jumping.
If the injury was preceded by kidney disease, then the bruise occurs with the most minor impacts, even with a fall. And shocking factors include even shock-wave pulses of low energy.
According to statistics, the left kidney is more often damaged, as it is somewhat lower and less protected by the ribs.
The ICD-10 codes are:
- S37.- trauma to the pelvic organs;
- S37.0 - kidney trauma;
- S37.00 - organ trauma without open peritoneal injury
- S37.01 - trauma with open wound of peritoneum;
- S37.7 - trauma to several pelvic organs.
Pathogenesis
Under the organ injury means trauma, in which there is a large hemorrhage to the parenchyma of the kidney without breaks. The degree of change varies - from minor hemorrhages to complete destruction of the renal tissue. Damage may not at all violate the integrity of the organ, but on the functionality of the kidneys the bruise is even worse.
Hemorrhage naturally leads to the formation of a hematoma: small vessels under pressure burst and blood is in tissues. In more severe injuries, there is a danger of clogging of blood vessels.
The severity of the injury is classified as follows:
- 1- subcapsular hematoma without tissue rupture. Damage leads to the loss of 1-15% of nephrons, which does not affect the functions of the organ;
- 2 - a circumferential hematoma, damage to the surface cortical layer is possible. A bruise with hematuria, that is, bloody discharge in the urine, is not accompanied;
- 3 - lesions of the renal tissue to a depth of 1 cm are observed. Hematuria is present. Possible loss of up to 30% of the renal parenchyma;
- 4 - the injuries seize the cup-and-pelvis system. Possible thrombus of the renal artery;
- 5 - multiple irreversible tissue changes, there is a high probability of thrombosis of the renal artery or vein. Irreversible dystrophic kidney damage can reach 65%.
2 the first stages are considered easy, little impact on the functions of the organs. In this case, treatment at home is permitted, but on condition that a visiting doctor visits. 3-5 stages require conservative treatment. It is more fair to attribute them not to bruises, but to injuries of the kidneys.
A 95% kidney injury is accompanied by pain, if it is an isolated trauma, and 100% if combined. The painful syndrome causes a growing hematoma - it presses on the peritoneum and stretches the fibrous capsule. At the same time, ischemia of the renal parenchyma begins, and the urinary tracts are clogged with blood clots.
Hematoma also provides swelling in the area of the damaged kidney. It causes the accumulation of blood and urine in the cellulose behind the peritoneum and near the kidney. Hematoma usually occurs on the back. However, it can occupy the whole area from the diaphragm to the pelvis, and 2-3 weeks after the injury it can form on the hips and on the scrotum.
Symptoms of
The bruised kidneys, even not heavy due to the formation of the hematoma immediately makes itself felt. Symptoms can be different, especially with existing kidney diseases.
For closed injuries, the following 3 signs are considered to be characteristic:
- pain in the lumbar region - the sign appears in 95%.The pain is different: blunt, sharp, stitching, irradiating to the groin or thigh;
- tumescence on the lower back - occurs in 10%, usually in more severe cases, because for this blood or urine with blood must penetrate into the pericardial cellular tissue;
- hematuria is the appearance of blood in the urine. This is the most indicative sign of a kidney injury. However, it may not appear immediately, but in a few days - secondary hematuria.
In addition, because of pressure on the peritoneum and loss of blood, there are other symptoms: bloating, vomiting, pale skin and mucous membranes, hyper- and hypotension, and so on.
Brightness and the number of symptoms depends on the degree of severity:
- . At an easy stage of perineal hematoma is not observed, the hematuria is small, there are no signs of irritation of the peritoneum.
- In the middle stages, blood pressure drops, the hematuria increases, blood clots accumulate in the bladder, which makes it difficult to urinate and can lead to an acute delay. The stage of moderate severity is very conditional, and in most cases leads to a transition from relatively satisfactory to a state of moderate severity.
For severe stages are characterized by severe pain, macrogematuria, urogematoma in the lumbar region. Against this background, there are signs of internal bleeding. As a rule, such a serious condition is the result of a complex trauma.
Diagnosis
The reason to consult a doctor in such cases is back pain. Hematuria can be so insignificant that it is invisible to the eye.
Based on the patient's complaints, a laboratory test is assigned:
- a general urine test - allows to identify hematuria. The latter indicates damage to the kidney;
- general blood test - indicative is a low level of hemoglobin and hematocrit in the blood, indicating anemia or latent bleeding;
- perform separate urinary samples to rule out other possible diseases.
Instrumental methods are used to clarify the diagnosis, detect other injuries, determine hematomas and so on:
- The most informative are the X-ray methods. They allow you to assess the damage, accurately determine the presence of hematomas, and, most importantly, determine the attendant injuries.
- ultrasound is the most safe method of examination and is quite informative: with the help of ultrasound diagnoses in 80% of cases. It allows to establish the degree of change in the renal parenchyma, the location of hematomas.
- In case of disturbances in the blood supply, radiopaque methods are additionally prescribed. Angiography and MRI, because the condition of the vessels and hemodynamics, these methods can be evaluated to a much greater extent.
What to do and how to treat
Kidney injury, if not complicated by the development of any disease or concomitant severe trauma, does not require surgical intervention. However, even with a mild disease, bed rest is necessary. The most dangerous in this trauma is subcapsular hematoma: during movement, it exerts pressure on the kidney tissues, which contributes to further damage to the blood vessels, and, therefore, the spread of trauma.
With an easy degree of ailment, a kidney injury can be treated at home, and with good hemodynamics and a relatively healthy patient's condition does not include medical therapy. The main condition for recovery is complete rest for 2 weeks.
Other measures are required:
- lumbar cooling in the first 1,5-2 days - helps to relieve inflammation and reduce the hematoma. Used ice, cold wrapping;
- bed rest;
- fluid restriction until the kidney function is restored;
- removal of pain syndrome - if cold does not help, appoint a novocain blockade, analgesics;
- physiotherapy - after 3-5 days after the injury, electrophoresis, magnetotherapy, UHF therapy are prescribed. Their task is to accelerate the resolution of the hematoma;
- controls hemoglobin and hematocrit in the blood, as well as the presence of blood in the urine.
In a more severe condition, the patient is hospitalized and treated by a doctor. Therapy includes the administration of antibiotics and uroantiseptics in order to suppress or prevent inflammation. Also prescribed painkillers and hemostatic drugs in order to prevent the appearance of gross scars during healing.
Medical statistics show that with moderate severity of the disease conservative therapy gives better results than surgery. The consequence in the form of development of hypertension is the same.
Unstable hemodynamics and increasing in size, pulsating hematoma are indicators for surgical intervention. Also, the operation is resorted to with combined injuries.