Blunt Renal Trauma: A Case Report

Yıl 2022, Cilt: 5 Sayı: 1, 34 - 36, 09.03.2022

Berk Beyinç İnan Beydilli , Fevzi Yılmaz , Engin Deniz Arslan

https://doi.org/10.54996/anatolianjem.999525

Öz

Aim: The ratio of renal traumas among all abdominal traumas is undeniable. With the developing technology, the non-operative approach took place of the operative interventions in the management of renal trauma. In this paper, we compiled a short review about renal trauma and its management based on a patient who was admitted to the emergency department with post-traumatic hematuria.

Case: A 29-year-old man is admitted to the emergency department with a complaint of bloody urine and left flank pain. Medical history revealed that he fell down from a height of 1 meter 2 days ago. Left costa-vertebral angle (CVA) tenderness was positive on physical examination. Erythrocyte (1263 P/HPF) and Leukocyte (56 P/HPF) counts were elevated in urinalysis. The patient underwent contrast-enhanced abdominal computed tomography (CT) scan to rule-out kidney injury and left kidney contusion and perirenal hematoma that was in accordance with grade 2renal injury was detected. No intervention was not considered for the patient, he was admitted to the ward, and he was discharged after an uneventful hospital stay.

Conclusion: The incidence of kidney injuries is higher in the young population aged between 31 and 38 years and men account for 72-93% of these cases. Blunt renal injuries, accounting for 71-95 % of renal trauma cases, are more common than penetrating injuries. Motor vehicle accidents are the main cause of blunt trauma, followed by falls, sports, and pedestrian accidents. Up to 95% of blunt renal injuries are minor and treated conservatively as in our case. Currently, conservative management is the preferred therapeutic modality in hemodynamically stable patients with low-grade kidney injury.

Anahtar Kelimeler

Renal injury, hematuria, blunt trauma

Künt Renal Travma: Bir Olgu Sunumu

Öz

Amaç: Batın yaralanmalarının içinde böbrek yaralanmaları göz ardı edilemeyecek sıklıktadır. Gelişen teknolojiyle birlikte böbrek yaralanmasının yönetiminde cerrahi olmayan yaklaşım cerrahi yönetimin yerini almıştır. Bu yazıda acil servise post travmatik hematüri ile başvuran olguya dayanarak böbrek yaralanması ve yönetimini kısaca gözden geçirdik.

Olgu: Yirmi dokuz yaşında erkek hasta, kanlı idrar ve sol yan ağrısı şikayeti ile acil servise başvurdu. Öyküsünde 2 gün önce 1 metre yükseklikten düştüğü bilgisi öğrenildi. Fizik muayenede sol kosta-vertebral açı (SVA) hassasiyeti pozitifti. Tam idrar tahlilinde eritrosit (1263 P/HPF) ve Lökosit (56 P/HPF) sayıları yükseldi. Hastaya böbrek hasarı ekarte etmek için kontrastlı karın bilgisayarlı tomografisi (BT) çekildi ve sol böbrek kontüzyonu ve evre 2 böbrek hasarına uygun perirenal hematom saptandı. Hastaya herhangi bir cerrahi müdahale düşünülmedi, servise alındı ve sorunsuz bir hastanede yatış sonrası taburcu edildi.

Sonuç: Böbrek yaralanmalarının insidansı 31-38 yaş arası genç nüfusta daha fazladır ve bu olguların %72-93'ünü erkekler oluşturmaktadır. Renal travma vakalarının %71-95'ini oluşturan künt renal yaralanmalar penetran yaralanmalardan daha yaygındır. Künt travmaların başlıca nedeni motorlu taşıt kazaları olup, bunu düşmeler, spor ve yaya kazaları izlemektedir. %95'e varan künt böbrek yaralanmaları minör yaralanmalar olup bizim olgumuzda olduğu gibi konservatif olarak tedavi edilir. Düşük dereceli böbrek hasarı olan hemodinamik olarak stabil hastalarda şu anda konservatif tedavi tercih edilen tedavi yöntemidir.

Anahtar Kelimeler

Renal yaralanma, hematüri, künt travma

Kaynakça

• Lee YJ, Oh SN, Rha SE, Byun JY. Renal trauma. RadiolClin North Am. 2007 May;45(3):581-92
• Alonso RC, Nacenta SB, Martinez PD, Guerrero AS, Fuentes CG. Kidney in danger: CT findings of blunt and penetrating renal trauma. Radiographics. 2009 Nov;29(7):2033-53.
• Chouhan JD, Winer AG, Johnson C, Weiss JP, Hyacinthe LM. Contemporary evaluation and management of renal trauma. Can J Urol. 2016;23(2):8191-8197.
• Erlich T, Kitrey ND. Renal trauma: the current best practice. Ther Adv Urol. 2018;10(10):295-303.
• Voelzke BB, Leddy L. The epidemiology of renal trauma. TranslAndrol Urol. 2014 Jun;3(2):143-9.
• Gourgiotis S, Germanos S, Dimopoulos N, Vougas V, Anastasiou T, Baratsis S. Renal injury: 5-year experience and literature review. Urol Int. 2006;77(2):97-103.
• Rous SN. The value of serial selective renal angiography in the delayed management of renal trauma. J Urol. 1972 Mar;107(3):345-7.
• Viola TA. Closed kidney injury. Clin Sports Med. 2013 Apr;32(2):219-27
• Gourgiotis S, Germanos S, Dimopoulos N, Vougas V, Anastasiou T, Baratsis S. Renal injury: 5-year experience and literature review. Urol Int. 2006;77(2):97-103.
• Singh S, Sookraj K. Kidney Trauma. [Updated 2021 Jul 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan.
• Bright TC, White K, Peters PC. Significance of hematuria after trauma. J Urol. 1978 Oct;120(4):455-6
• Taylor GA, Eichelberger MR, Potter BM. Hematuria. A marker of abdominal injury in children after blunt trauma. AnnSurg. 1988 Dec;208(6):688-93.
• Goldman SM, Sandler CM. Urogenital trauma: imaging upper GU trauma. Eur J Radiol. 2004 Apr;50(1):84-95.
• Harris AC, Zwirewich CV, Lyburn ID, Torreggiani WC, Marchinkow LO. Ct findings in blunt renal trauma. Radiographics. 2001 Oct;21 Spec No: S201-14
• Uflacker R, Paolini RM, Lima S. Management of traumatic hematuria by selective renal artery embolization. J Urol. 1984 Oct;132(4):662-7.
• Morey AF, Broghammer JA, Hollowell CMP, McKibben MJ, Souter L. Urotrauma Guideline 2020: AUA Guideline. J Urol. 2021;205(1):30-35.
• Sujenthiran A, Elshout PJ, Veskimae E, et al. Is Nonoperative Management the Best First-line Option for High-grade Renal trauma? A SystematicReview. EurUrolFocus. 2019;5(2):290-300.
• Veeratterapillay R, Fuge O, Haslam P, Harding C, Thorpe A. Renal trauma. Journal of Clinical Urology. 2017;10(4):379-390.