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Injury - kidney and ureter
Alternative namesKidney damage; Toxic injury of the kidney; Kidney injury; Traumatic injury of the kidney; Fractured kidney; Inflammatory injury of the kidney; Bruised kidney; Ureteral injury
DefinitionThis injury is sustained to the upper urinary tract (kidneys and/or ureters).
Causes, incidence, and risk factors
The kidneys are located in the flank (back of the upper abdomen at either side of the spinal column). They are deep within the abdomen from the front and are protected in the back by the spine, lower rib cage, and the strong muscles of the back.
This location protects them from many external forces, and they are well padded for a reason -- kidneys are highly vascular organs, which means that they have a large blood supply which could cause severe bleeding, if disrupted.
The extent of bleeding depends on the location and the degree of injury. Kidneys may also bleed profusely if they are damaged centrally (on the inside), and this is a life-threatening injury. Fortunately, most kidney injuries caused by blunt trauma occur periperally, only causing bruising of the kidney (usually a self-limiting process).
People with undiagnosed kidney conditions, such as anigomyolipoma (benign tumor), ureteropelvic junction obstruction (congential or acquired UPJ Obstruction), and other disorders, are more susceptible to kidney injuries and more likely to have serious complications if they occur.
Other causes of kidney injury and bleeding are medical procedures. Kidney biopsies, nephrostomy tube placements, or other surgeries can cause an abnormal connection between an artery and vein (arteriovenous fistula). This is usually a self-limiting problem, but close observation is usually needed.
Injury to the kidney can also cause violation of the urinary tract, causing leakage of the urine from the kidney.
Each kidney filters about 1700 liters of blood per day and concentrates fluid and waste products into about 1 liter of urine per day. Because of this, the kidneys receive more exposure to toxic substances in the body than almost any other organ. Therefore, they are highly susceptible to injury from toxic substances.
Analgesic nephropathy is one of the most common types of toxic damage to the kidney. Exposure to lead, cleaning products, solvents, fuels, or other nephrotoxic chemicals (those which can be toxic to the kidney) can damage kidneys.
Excessive buildup of body waste products, such as uric acid (that can occur with gout or with treatment of bone marrow, lymph node, or other disorders) can also damage the kidneys.
Ureteral injuries (injuries to the tubes which carry urine from the kidneys to the bladder) can also be caused by trauma (blunt or penetrating), medical procedures, and other disease processes in the retroperitoneum. The traumatic injuries should be explored, if the patient is undergoing laporatomy for other indicated intra-abdominal injury (and the index of suspicion is high).
Medical therapies (such as OB/GYN surgeries, prior radiation/chemotherapy, and previous abdominopelvic surgeries) are risk factors for ureteral injuries. In other cases, extraperitoneal disease processes (such as retroperitoneal fibrosis (RPF), retroperitoneal sarcomas, or metatstatic lymph node positive cancers) can interfere with normal ureteric processes and cause obstruction/hydroureteronephrosis (swelling of ureter and kidney from urinary backflow).
Acute or emergency symptoms:
Signs and tests
A history of physical injury, exposure to potentially toxic substances, or recent infections or illness may indicate the source of injury to the kidney. If there is loss of blood, examination by touch ( palpation ) may reveal extreme tenderness over the kidney.
There may be signs of hemorrhage and shock , including rapid heart rate and falling blood pressure . Toxic injury or injury from inflammation may cause acute or chronic renal failure .
Treatment goals include treatment of emergency symptoms and prevention or treatment of complications. Most cases of external trauma result in mild bruises that heal spontaneously.
Analgesics may be needed for pain relief. Hospitalization and close observation may be required because of the risk of internal loss of blood from a traumatically injured kidney.
For example, if an isolated ureteral injury is discoved a week later, a clinician may divert the urine with the nephrostomy tube, let the inflammation settle down, and elect to operate at a later date for the definitive treatment.
The kidney may return to normal function, or it may experience acute or chronic failure. If only one kidney is affected, there may be no symptoms from the failed kidney, because the second (healthy) kidney functions normally and is adequate for normal health.
The outcome varies depending on the cause and extent of injury. The damage may be mild and reversible, it may be immediately life-threatening, or it may be prolonged and result in complications.
Calling your health care provider
Call your health care provider if symptoms indicate injury to the kidney or ureter, especially if there is a history of physical injury, exposure to potentially toxic substances, illness, or infection.
External damage may be prevented by using general safety precautions -- using appropriate safety equipment during work and play, wearing seat belts, and driving safely.
Use cleaning products, solvents, and fuels as directed in a well-ventilated area because the fumes may also be toxic. Be aware of potential sources of lead poisoning , such as old paints, vapors from working with lead-coated metals, alcohol distilled in recycled car radiators, and similar sources.
Update Date: 5/25/2002Young Kang, M.D., Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT