Renal Trauma Clinical Presentation

Updated: Jan 01, 2019
  • Author: Dennis G Lusaya, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Presentation

History

When possible, obtain a focused history of the injury from the patient, prehospital personnel, and available bystanders. Important information relevant to genitourinary injury includes the mechanism of injury, prehospital care provided, and any previous history of genitourinary injury or disease. As the genitourinary tract is seldom injured in isolation, a meticulous physical examination is crucial to avoid missing occult injuries. The clinical clues to a potential renal injury are nonspecific, but include: bruising, pain, or tenderness to the flank or abdomen; posterior rib or spine fractures; gross hematuria; other organ injury; microhematuria, defined as ≥3 to 5 RBCs/HPF; and shock, defined as a systolic blood pressure ≤90 mmHg. 

The degree of renal injury does not correspond to the degree of hematuria, since gross hematuria may occur in minor trauma and only mild hematuria in major trauma. Not all patients sustaining blunt renal injuries require full imaging evaluation. Only those with gross hematuria or microscopic hematuria with shock (systolic blood pressure < 90mmHg) should undergo imaging and those without microscopic hematuria with shock need not.

However, in cases where there is a strong suspicion of renal injury based on physical examination or associated injuries arise, renal imaging is warranted. This is especially true of victims of rapid deceleration injuries, who may have renal injury without the presence of hematuria.