What is Kidney Injury
Kidney injury due to various external forces acting on the body and lead to kidney damage, clinical hematuria, shock, pain and swelling as the main feature of traumatic disease.
Kidney injury incidence rate is not very high, because the hidden kidney anatomical location, good protection both inside and outside its front and rear, under normal circumstances, is not easy injured, but the kidney as a solid organ, the structure is relatively fragile, such as from the abdomen or waist violence the middle of the kidney area also can cause damage, especially in the renal morphological abnormalities or pathological cases, injured opportunity is much higher than the normal high. Sometimes the muscles strong contraction or body subject to strong vibration, can be normal kidney injury. Abdominal puncture wounds from 6% to 14% of injury incidence rate of the foreign statistics renal injury accounting for hospitalization of 1% to 3% of the trauma cases, accounting for 8% to 10% of the abdominal injury, 70% of blunt closed injury; and kidneys. Kidney damage often associated with intra-abdominal injury of other organs, the clinical easily be overlooked and missed, until the occurrence of bleeding, urinary extravasation, infection and abscess formation are aware of only seriously affect the final outcome. Therefore, the prognosis of kidney injury depends on the diagnosis is timely. Long as they can make a correct diagnosis early and to take appropriate therapeutic measures, due to various complications of kidney damage is completely avoidable.
The disease is a traditional Chinese medicine "low back pain", "hematuria" range.
Symptoms of Kidney Injury
(1) pain in the injured side. Kidney area or upper abdominal pain. Generally dull, because. Renal capsule tension increases or soft tissue injury. Blood clots through the ureter and renal colic. Urine and blood into the abdominal cavity or the abdominal visceral injury, abdominal pain.
Hematuria kidney injury symptoms, gross hematuria, a few only microscopic hematuria. Approximately 40% of patients with renal injury hematuria. Hematuria severity and degree of kidney damage is not necessarily the same, sometimes mild hematuria, or only microscopic hematuria, but the Department of severe renal injury, such as the ureter amputation, blood clots blocking the ureter, is the amount of rupture of the renal pelvis, renal pedicle injury or wounded is in shock and anuria state. This end asks whether the injured urination. Whether hematuria important. Should be timely so that the patient voiding checks, if necessary, catheterization check. 2 signs
(1) shock signs
The shock is a very important performance after kidney injury, traumatic shock and / or hemorrhagic shock. Its occurrence and severity often depends on the degree of injury, the amount of bleeding and the presence of other organs associated injuries. About 40% of the merged shock open injury, about 85% combined with shock, blunt injury. In blunt. Kidney damage, if mild hematuria or microscopic hematuria only, while the combined shock should be considered for severe kidney injury including. Renal pedicle injury or concurrent other organ damage.
(2) peritoneal irritation
Urine and blood into the abdominal cavity or the abdominal visceral injury can occur peritoneal irritation.
(3) painful lumps
Local kidney injury often varying degrees of tenderness and muscle rigidity. Bilateral comparison checks, the difference is very obvious. The damage severe cases, often due to the accumulation of blood and extravasation of urine in the renal surrounding the formation of painful lumps. A short time after the injury due to increased muscle tone, tumors often difficult to find, but the waist and kidney area fullness and abdominal percussion dullness on the injured side are prompted perirenal lump. In addition, the injured side ecchymosis or skin abrasions.
What Causes Kidney Injury
Injury due to and injury mechanism
1 open injury
More common in wartime abdominal shrapnel injuries, gunshot wounds and other organ damage, more than about 90% of the merger, according to the statistics of such openness kidney injury. Sharp knife the open renal damage caused, usually in wartime can be seen, there are about 80% with abdominal organ injury, which colon, liver and spleen of the most common associated injuries.
2. Blunt injury
Including direct violence, indirect violence, muscles strong contraction of other reasons. Direct violence by the upper abdomen or lower back kidney area due to being squeezed by the impact of external forces or waist. Is usually the most common causes of injury. Indirect violence is often due to the high-speed movement sudden deceleration, height fall down, feet or buttocks ground detonation wave impact due. The body suddenly turning, carry a heavy load too much force and due to strenuous exercise strong contraction of the muscle, can also lead to kidney damage.
The kidney pathological conditions such as hydronephrosis, stones, tuberculosis, the slight external force, closed renal injury can occur.
3 iatrogenic injury
Iatrogenic kidney injury means the surgery or the purposes of endoscopy and treatment to kidney undue damage, such as accidental perforation, bleeding, etc..
Tests and Diagnosis for Kidney Injury
(1) Where the waist or kidney area trauma history, hematuria, pain or shock performance, can basically be diagnosed with kidney damage.
(2) X-ray examination is not only to provide a further basis for the diagnosis of renal injury, and play a crucial role in the diagnosis and treatment of severe combined injury. Associated with the rupture of the abdominal cavity organs such as kidney damage, abdominal plain film examination not only be able to see the signs of kidney damage, and can be found in the free gas below the diaphragm; shrapnel or gunshot wounds, to learn whether the metal foreign body and its parts; such accompanied clavicle fracture line plain film examination, accidentally discovered high cervical spine fracture. Due to the high incidence of the open renal injury associated injuries, plain film examination is particularly important.
(3) intravenous urography injury classification of renal damage vital should the plain film examination completed at the same time, in order to avoid delay in treatment time. Developing often not satisfied with conventional angiography dose due to reduce the impact of impaired renal function, renal blood flow, so to use the high-dose intravenous urography, multi developing clear, valuable to determine the degree of injury.
(4) CT accurately estimated renal injury, but the exact classification of the injury, it is not a substitute for intravenous urography. CT is an important complement to check the renal pedicle injury, when instability in injury or invasive examination does not allow line as the first choice.
(5) renal artery angiography, ultrasound and radioisotope scanning are not suitable for emergency cases, but the judgment of the prognosis of kidney injury, an optional application.
(6) In addition to a clear diagnosis of kidney injury clinical need to pay attention to the presence or absence of intra-abdominal injury of other organs, such as spleen damage, liver damage, pancreas damage.
2 Differential Diagnosis
(1) liver, spleen injury
The abdominal puncture withdrawable solidification bloody fluid containing bile, B ultrasound and CT examination can further confirm the diagnosis.
(2) pancreatic injury
Apparent peritoneal irritation, the abdominal puncture white liquid amylase significantly higher.
2 critical indicators
(1) hemorrhagic shock
The pale limbs Jueleng, faster pulse, decreased blood pressure, decreased hemoglobin and red blood cells.
(2) a large number of gross hematuria.
(3) severe urinary extravasation, pain in the kidney area mass increases, or obvious peritoneal irritation.
Treatments of Kidney Injury
(A) Western medicine treatment
Anti-shock treatment principles, hemostatic, anti-infective and repair damage.
2. Treatment measures
(1) emergency treatment
With shock should be treated early, rapid blood transfusion, recovery, and to determine whether the merger other organ damage. In patients with severe renal injury, even if the blood pressure in the normal range, must also give control shock measures, close observation of pulse, blood pressure, while examination of the urinary tract and other systems of the body. Should be accompanied by shock patient in shock has been corrected and is in stable circumstances, necessary qualitative examination as soon as possible to determine the scope and extent of renal injury, and further treatment.
(2) The non-surgical treatment
Kidney contusion, light kidney laceration and not combined with thoracic, abdominal organ injury cases, should be held in non-surgical treatment, including absolute bed rest for two weeks, to add volume to maintain water and electrolyte balance, maintain adequate urine output, and close observation of blood pressure, pulse, breathing and body temperature changes, broad-spectrum antibiotics to prevent infection, the necessary drugs to stop bleeding and pain medications.
With severe renal laceration laceration depth of calyceal or not yet reached the degree of comminuted, but the Department of the multiple lacerations and some have been connected with the collection system, in close observation of downlink non-surgical treatment. Surgical treatment of the following conditions should be: positive anti-shock treatment of shock has been corrected, but unstable blood pressure or appear again shock; without reducing persistent hematuria, red blood cell count, hemoglobin and hematocrit showed a progressive decline; renal masses. boundaries without narrowing and widening.
A. openness. Kidney damage;
B. The inspection confirmed that the to crush kidney injury;
C. The inspection confirmed the renal pelvis rupture;
D. Intravenous urography check damage kidney does not develop renal arteriography confirmed renal pedicle injury.
E. with abdominal organ damage.
(2) surgical approach
A. perirenal drainage adapted to the drainage of open injury debridement and drainage, or illness the critical exploration injured kidney to control bleeding; of concurrent urine or blood extravasation after secondary infection. Right. Renal bleeding points, according to the disease and conditions, ligation, suture, or tamponade.
B. renal artery embolization
Special cases in a dangerous state, the application of the injured side of the renal artery tamponade, waiting for the patient's condition improved further processing.
C. renal repair or partial nephrectomy
Catgut mattress plus fat pad stitched rip; the multiple lacerations difficult suture catgut plaited mesh cover surrounding the kidney to stop bleeding; semi-serious kidney laceration can be used for partial nephrectomy.
Crushed or renal vascular tear widely, in fact, can not be reserved and confirmed the contralateral renal, before removal of the ipsilateral kidney. Suspected intra-abdominal organ injury, should be further exploration of the abdominal cavity.
(B) TCM treatment
1 qi stagnation
Main symptoms: of Yao Lei Ministry pain, blood in the urine, full of local swelling, mass formation, obvious tenderness, muscle rigidity, dull red, Desk thin yellow pulse string.
Governing Law: blood circulation Tongluozhitong the.
Cases Fang Zhu Yu Tang: body pain.
Commonly used drugs: Angelica, Chuanxiong, peach kernel, safflower, myrrh, Wulingzhi Cyperus, Achyranthes, turtle worms.
Shuangbai the topical ointment waist. 2 times a day.
Panax end-3g, blunt, 3 times a day.
2. Stasis heat each knot
Main symptoms: waist painful swelling, obvious tenderness, fever thirst, constipation, scanty dark urine, red tongue, yellow coating, pulse a few flood.
Governing Law: detoxification, removing stasis:
The cases side: Huanglianjiedu, soup aggregate soup Taohongsiwu.
Commonly used drugs: Coptis, Phellodendron, skullcap, gardenia, rhubarb, Achyranthes, peach, Chuanxiong, red peony soap thorn, Shan Jia.
Golden Plaster waist, 2 times a day.
Pus aspiration or incision and drainage.
Shuanghuanglian Powder Injection 3g added 0.9% saline intravenous drip.
3 gas with the blood off
Main symptoms: a large number of gross hematuria, pale limbs Jueleng, cold sweats, palpitation and shortness of breath, the fine pulse rate, pale tongue, white.
Governing Law: Qi solid off, nourishing and bleeding.
Commonly used drugs: Ginseng, aconite, astragalus, Codonopsis, angelica, donkey-hide gelatin, Agrimony.
Korea ginseng injection 20ml added 0.9% saline, intravenous infusion.
Shenfu Injection 60ml added to a 10% glucose solution intravenously.