Kidney damage, approaches to diagnosis and treatment
One of the most common types of injuries of the internal organs of a person is damage to the kidneys. Their frequency is 14.2% with closed injuries of the abdominal cavity, and 6.6% with open abdominal injuries. These organs are vital, their trauma can be accompanied by the development of acute renal failure, which can lead to death, as there is a pronounced intoxication of the body with metabolic products.
Causes and types of injury
The main causes of kidney damage are various types of injuries of the abdominal cavity and abdomen. Injuries can be penetrating, with violation of the integrity of the skin and closed, without those. They are classified according to its type, its location and severity. In appearance, the following are distinguished:
- contusion;
- rupture without lesion of pelvis;
- rupture with pelvic injury - a more severe defect in which kidney failure develops;
- crushing;
- gap;
- separation from the vascular pedicle and ureter.
Important! The crushing injury of the kidney is the most severe kind of damage, in which the organ can not be restored surgically, but must be removed.
Localization distinguishes:
- injuring the body of the kidney;
- of the upper or lower pole;
- of the vascular pedicle and ureter.
There are 3 degrees of severity of kidney damage:
- lungs - usually accompanied by tearing of a fibrous capsule with small hemangiomas( bleeding);
- lesions of moderate severity - in this case, except the capsule, parenchyma suffers, but the defects are minor;
- severe degree - accompanied by significant damage to the parenchyma of the organ, up to its crushing.
Important! Treatment of injuries of moderate severity and severe complications of the kidney is only surgical.
Symptoms of the disease
Symptoms of closed injuries are characterized by varying degrees of intensity, they include:
- pain in the lumbar region - always accompanies any traumatic organ damage, the intensity of pain depends on the severity of the lesion;
- soft tissue swelling in the lumbar region - due to accumulation in blood tissues, with damage to the vessels of the kidney, urine, ureter, the swelling and swelling severity depends on the caliber of the injured vessel;
- hematuria - the appearance of blood in the urine with urination, indicates the presence of bleeding from the damaged vessels, the blood in this case does not accumulate in the soft tissues, and leaves the ureters with urine.
Important! The absence of hematuria does not speak about the absence of bleeding in the damaged kidney, since the blood may not go out on the ureters, but accumulate in the soft tissues around it in the form of a hematoma.
With an open trauma to the kidneys, the symptoms are almost the same, in addition there is a marked bleeding from the damaged skin.
Additional diagnosis of the disease
In the case of open trauma, to localize the wound, it is possible to judge with some degree of certainty the presence of kidney damage. When there is a closed trauma, it is more difficult to clinically diagnose a diagnosis, therefore additional laboratory and instrumental methods of investigation are necessarily applied, allowing to assess the nature of the lesion, its localization and severity:
- the clinical analysis of a blood - on a level of a hemoglobin and a degree of its decrease allows to judge about an expression of a bleeding;
- clinical analysis of urine - the appearance of protein, blood, erythrocytes in urine with microscopy make it possible to establish a factual damage to the kidneys;
- ultrasound( ultrasound) is a fast method of instrumental research, visualizes the size of the kidney, its condition and the presence of formations in it;
- excretory urography is an x-ray method of investigation, the essence of which is intravenous administration of a contrast agent that is excreted in the kidneys, allows to assess the condition of the organ, to reveal the ureteral lacerations( the contrast material is visualized in soft tissues);
- computed tomography( CT) is a high-precision radiographic method for examining lesions, allowing to visualize even small changes in the parenchyma and capsule.
Treatment of
The choice of tactics for treating kidney damage is determined by the type of injury, localization and severity:
- closed trauma of mild severity - conservative medication is usually used aimed at restoring kidney function, preventing infectious complications and late bleeding;
- acute damage with bleeding - after diagnosis, determination of localization and severity of the lesion, surgical treatment is performed aimed at stopping bleeding and restoring the anatomical integrity of the organ;
- open trauma of the kidney - due to damage to the integrity of the skin, the surgeon conducts a wound audit, determines the presence of trauma and performs activities aimed at an emergency stop of bleeding, to avoid the development of hypovolemic shock.