Kidney damage

Kidney damage are closed (subcutaneous breaks) and open (firearms, puncture, cut wounds of the kidneys).
Subcutaneous breaks kidneys caused by the attacks, strokes, sdavlennoy, impacting directly on the kidney through the outer skin from the back, front or side wall of the abdomen and sometimes simultaneously from two sides. In peacetime are bumps in the lumbar region (fist, elbow, sports injury, etc.,), falling on the lumbar region of heavy cargo, compression buffers cars, wheels, etc., In wartime, is the fall in the lumbar region from the air waves, injury mechanized transport and other
Indirect causes include sudden shaking of the body as a result of falling on his feet, a sharp decrease of the abdominal and lumbar muscles when lifting weights. All these factors can cause acute offset kidney and Bang it on XII the edge of the transverse processes of the vertebrae.
With closed injury of the kidney plays a big role vnutripolostnoe hydraulic pressure depending on the degree of filling the vessels of the kidney blood and pelvis urine at the time of injury.
Subcutaneous damage to the kidneys can be divided into five groups.
1. Damage capsules kidneys, accompanied by large hemorrhages between fat and fibrous capsule (Fig. 127).
2. Breaks renal parenchyma, not reaching the pelvis or cups. Hematuria minor or absent. Urinary infiltration no (Fig. 127, b).
3. Breaks renal parenchyma, reaching cups or pelvis. There is profuse hematuria and perinephral urogenital, which can descend down to the inguinal ring and scrotum (Fig. 127).
4. Full ruptured kidneys. The kidney is broken into separate parts. Some of them are free, others retain the link to the gates of the kidney. Bleeding becomes large, but may be absent. Urinary infiltration occurs as a rule (Fig. 128).

ruptured kidney
Fig. 128. Ruptured kidneys.

5. Damage to the gates of the kidneys. Isolated injuries of the pelvis or ureter are accompanied by slight hematuria and abundant urinary infiltration. If the damage is the major vessels of kidneys often death occurs as a result of severe blood loss and shock. If the patient does not die immediately after the injury, develop extensive perinephral hematoma. If the damage is only one Central artery kidney can be sustainable if the whole of Vienna.
Of damages, related closed injury of the kidney, fractures are a frequent XII, sometimes XI and X ribs, damage pleura, intraperitoneal bodies.
For minor injuries kidney General condition is violated little heavy damage often accompanied by shock.
Perinephral urogenital formed with significant bleeding from damaged kidneys and urinary infiltration retroperitoneal fat due to damage of the pelvis or cups.
While gap peritoneal blood and urine, pouring into the abdominal cavity, causing the development of peritonitis.
The most frequent (in 95% of cases) and an important sign of injury to the kidney is hematuria. It is not only in the removal of the ureter or the complete rupture of blood vessels in the kidneys and when the obstruction of the ureter a blood clot.
The intensity hematuria not always corresponds to the severity of damage to the kidneys. In some cases, with extensive injuries kidney blood enters into surrounding the kidney tissue or in the peritoneum (if violated its integrity). In these cases, despite the absence or small size hematuria, gradually increasing the picture of internal bleeding-paleness of the skin, a flicker of pulse, a cold sweat. In such cases require urgent surgical intervention after the patient will be brought from a state of shock.
In mild cases the General condition of the patient remains satisfactory and hematuria after a few days or 1-2 weeks, stopped completely.
Diagnosis closed damage to the kidneys is based on the emergence of gematurii, following the injury or soon after. No hematuria difficult diagnosis, but in these cases is formed urogenital or develops a picture of internal bleeding that suggests a correct diagnosis. While damage of abdominal symptoms can last may mask signs of renal injury. In such cases during emergency laparotomy kidney damage can be recognized by the retroperitoneal hematoma.
If the patient can resort to cystoscopy, reveals what the kidney bleeding; using indigocarmina sample checks the function of the damaged kidney, and the availability and functional capacity of the second kidney, which is very important for the choice of method of surgical intervention.
For this appropriate excretory urography as a completely safe method of research. A few days after the termination hematuria, you can resort to retrograde pielografii.
Treatment. By itself intensive hematuria can not serve as an indication for surgical intervention. If there is no fall in blood pressure, anemia
Not increasing, there is no urohematin with surgery, one should not hurry. Most of these, patients can be cured without surgery.
If profuse hematuria and growing anemizatsii patient, the fall of the pulse and pressure, increasing urogenital shown term exposure kidneys.
Ruptured kidneys and deep breaks its parenchyma, penetrating to the pelvis, separation of the ureter or vessels require urgent nephrectomy. Organ-retaining operations (stitches on the renal parenchyma, resection of poles and so on) are produced at the surface breaks kidneys within the cortical layer, isolation pole or simultaneous damage both kidneys. Isolated damage the kidneys access to it, as a rule, vnebrachnyi lumbar. Before the surgery the patient must be inferred from a state of shock.