Kidney damage

Kidney damage can be closed (subcutaneous) and open isolated or combined with damage to other organs.
Closed kidney damage occur more frequently due to injury as a result of direct impact (impact) on the lumbar region, a sharp turn of the body and because of the shaking of the body at falling from height.
When closed kidney damage breaks parenhima kidney and renal vascular, renal capsule and vessels renal capsule, ruptured kidneys and even its separation from renal legs. Signs of kidney damage are: pain in the lumbar region, blood in the urine and increasing swelling and pain in the lumbar region due to the expiration of blood and urine in the retroperitoneal fat and education of urogenital. The intensity hematuria and slew lumbar hematoma not serve as an indicator of the degree of damage to the kidneys. The main feature heavy damage the kidneys is the worsening of the patient's condition, low blood pressure, clinic of internal bleeding.
Examination of suspected closed damage kidneys should include intravenous urography, which allows you to identify a function intact kidneys, and the degree of damage.
In most cases, damage to the kidneys treated conservatively: rest, bed rest, transfusion hemostatic of donations, hemostatic means and antibiotics to prevent the development of retroperitoneal phlegmon. At the time of treatment repeat x-ray examination and urine tests.
In those cases, when after damage the kidneys, the patient's condition is getting progressively worse, decreases blood pressure, reduced hemoglobin content in the blood, the patient should be operated to produce lumbotomy with revision of the kidney. With extensive damage to the kidneys produce its removal - nephrectomy.
Open kidney damage (injury) occur more often during war, there are fire, stab, stab. Signs of open damage the kidneys are: allocation of the blood and urine of lumbar wounds and hematuria. Treatment of open damage to the kidney is mandatory operations - lobotomie with revision of the kidney. During the operation strive to keep the kidney, nephrectomy produce at least.

Kidney damage divided into the subcutaneous (closed) and open. The latter can be stab, stab and gunshot, isolated or combined with damage to other organs.
Subcutaneous damage kidneys are not uncommon during transport, sports and an industrial injury. Occur much more frequently in men and children than women. The right kidney is damaged more left.
Closed kidney damage occurs due to direct injuries to the lumbar region (hit in the lower back, compression buffer trains, falling sideways on solid object), as well as an indirect impact (shock body at falling from height, sharp contraction of the muscles when you try to balance or to hold heavy falling object). Possible damage P. at impact and opposite the lumbar region. In wartime subcutaneous damage P. occur more frequently due to the impact of the shock of the blast wave.
With the direct injury damage may be caused fragments XI and XII of the ribs or transverse processes of the vertebrae, the major importance is the hydrodynamic effects in a tightly covered fibrous capsule P., in virtue of which the sharp compression it leads to breaks in the parenchyma and fibrous capsule. Acute dislocation of kidneys from the Lodge can happen due to a sharp approximation of lumbar muscles and edges caused protective muscle contraction in trauma. Acute impairment of renal blood circulation, mainly venous, accompanied by a rupture of small and large blood vessels. It is also possible separation short renal legs and a separation of a tense ureter (the pelvis-ureter segment).
Subcutaneous damage P. divided into five main groups. 1. Vessels rupture fat and fibrous capsule with education subcapsular and prerenalnaya hematomas (Fig. 28). 2. Non-penetrating breaks P. who do not achieve the cups or pelvis, held in radial cross direction, accompanied by small breaks fibrous capsule and education subcapsular and prerenalnaya hematomas (Fig. 29). 3. Penetrating breaks kidneys with the formation of deep cracks in the parenchyma, amounts to cups or pelvis, accompanied by damage to blood vessels significant diameter and education extensive prerenalnaya of urogenital (Fig. 30). 4. Ruptured kidney - deep breaks parenchyma with a margin of poles P.
In extensive bruising and imperialino blood, adipose tissue is located a few free or hanging on the vessels pieces., In these cases always observed extensive urogenital in the retroperitoneal space (Fig. 31). 5. The most severe damage - break kidney kidney legs and ureter is mostly accompanied by damage to the liver, spleen and other, as well as fractures of the spine and pelvis (Fig. 32).
Leading clinical sign of closed damage P. is hematuria (see). Hematuria can be short-term in mild concussion P., or when isolation of the ureter.
In the first hour after injury pain blurred expressed: patients mark difficulty and painfulness breathing on the corresponding side. Then localized pain in the lumbar region, spreading over the course of the ureter, palpation of the lumbar region is extremely painful. There are pain type renal colic caused by the passage of the ureter of blood clots. The abdominal wall and lumbar muscles on the side damage strained. Can show the signs of peritoneal irritation due to the formation of retroperitoneal hematoma. With increase its probed wibehouse infiltrate in the lumbar region, which can be seen during the inspection. Retroperitoneal hematoma, pushing inwards peritoneum, gives zone blunting of percussion sound in the lateral part of the abdomen; this zone does not move when you turn the patient's body.
In subcutaneous kidney damage necessary x-ray and urological examination. Review on an x-ray of the lumbar region are identified related fractures, scoliosis with a bulge in the healthy side due to reflex contraction of lumbar muscles, effaced contours P. and lumbar muscles on the side of the damage.
After removing the patient from shock and stabilize blood pressure level 100/50 mm RT. senior or higher to produce intravenous urography, which determines the presence and functional status of the second P. and gives an image of sdavljenia Cup pyelocaliceal system is damaged P. or satekov contrast in parrinello urohematin. No traces of contrast in cavities P. is not a measure of the gravity of the damage, as may be the result of spasm of blood vessels damaged P.
To clarify side of damage can be done chromatotherapy (see), which lets you see bleeding from the mouth of the ureter and to determine the functional state intact P. Often produce the retrograde pyelography - either directly after the injury P. and 2-3 days after her. Retrograde pyelography reveals the extent of damage P., the presence and magnitude of urogenital and the dynamics of the recovery process.
The severity of the damage is determined by the intensity and duration of internal bleeding, which are judged not by the degree of hematuria or the amount of lumbar hematoma, and the condition of the patient. Continuing, despite the blood, low blood pressure, decrease in hemoglobin, deterioration
the General condition of being forced to resort to operational assistance - lobotomie and revision of the kidneys.


Treatment. The most common operation is nephrectomy as extensive bruising among imperialino blood fiber quite difficult to determine the degree of renal impairment; however, it is necessary to strive for conserving surgery: resection of the pole, the closure of the gap pelvis, etc., In these cases the operation is complete drainage of the pelvis and perinephral space.
The majority of patients with closed injury P. successfully treated with conservative method, which consists in strict bed rest for 2-3 weeks, mandatory appointment of hemostatic means (blood transfusions, vikasola and calcium chloride) and in long-term use of antibiotics: penicillin, 100 000 IU 8 times a day, streptomycin 500 000 UNITS, 2 times per day or broad-spectrum antibiotics.
During treatment to monitor the blood and urine do after 2-3 days, the x-ray examination (intravenous urography or retrograde pyelography) 2-3 times.
The most serious complications of closed damage P.: education infected urohematin, septic melting of blood clots in blood vessels P. and secondary bleeding. In these cases it is urgent nephrectomy. If no bleeding, infected hematoma should be well drained. When conservative treatment may be a long time feverish state that depends on resorption of hematomas.
The prognosis for the closed kidney damage favorable. Among the consequences should be noted posttraumatic lithiasis, resulting from damage to the mucosa Cup-pelvis system or inlay blood clots; the formation of posttraumatic hydronephrosis as a result of significant scar changes in parauretral tissue and post-traumatic jade, which develops due to impaired blood circulation in the parenchyma P. and hypoxia.
Open injuries (wounds) of the kidneys most frequently observed during the war; they are dominated by fire (shrapnel and bullet). The main features of open damage on, are hematuria with clots, urine and blood from the wound.
When kidney damage shows lumbotomy and audit P. If these damages should also conserving surgery, using nephrectomy in extreme cases. Mandatory is a wide drainage prerenalnaya fiber, for preventing the urinary infiltration and purulent satekov. Open damage P. require immediate and persistent use of antibiotics.
The most dangerous complication are anuria due to injuries of both or P. P. and only reflex anuria, intensive protivosokovh activities and struggle with renal insufficiency, including peritoneal dialysis and hemodialysis.
Among the consequences of injuries to the kidneys in the first place is education strictor and Cicatricial deformities of the ureter and the subsequent development of hydronephrosis.
Possible damage to P. when catheterization of the ureter. They arise in cases of application of the ureteric catheter with mandrel and very deep (more than 25 cm) introduction it. Sign penetration of the catheter into the parenchyma P. serves a selection of blood on it, tight flow of contrast medium into the catheter. On the retrograde pyelogram contrast agent is distributed under the capsule, clearly delineates the path kidney or perforation of the fibrous capsule is manifested in the form of the formless contrast spots in the projection P.
You must immediately remove the catheter, assign patient antibiotics and hemostatic. Such damages are rare exceptions complications do not give.