In ICD-10, a kidney injury is listed under the number S37. Injury to the kidneys is extremely dangerous, as the consequences can be the most unpredictable. The nature of the damage can also be very different, because it is possible to deliver a dangerous blow during a simple fall on the asphalt (for example, a woman fell on her back and hit her back), the injury will not be as serious as after a fragmentation wound, but very unpleasant for a person. Moreover, from the available medical data it follows that in most cases, patients seek help after minor mechanical injuries than after penetrating wounds.
Of course, with seemingly frivolous injuries, many do not go to the urologist immediately, but wait for a speedy recovery at home, which is not recommended even with minor worries. Despite the fact that the renal region is quite inaccessible for serious damage, it can be said that trauma can provoke more severe damage to the body. It is worthwhile to examine in more detail where the kidneys are and how they hurt.
About the reasons
There are many reasons, but in peacetime they are quite commonplace. The most common causes are traffic accidents, fights, work-related or sports injuries. These incidents can even cause serious mechanical damage. These strokes are most dangerous for children in whom the injury rate in this area is much higher than that of an adult. Such a risk arises due to the anatomical features of the child, whose renal mechanisms are not yet very well “fixed”.
The danger of this injury lies not only in the stroke itself, but also in the features of the kidneys themselves, for example, if a person suffers from chronic kidney diseases, such as inflammation, nephroptosis and others, then the injury can lead to more serious consequences and prolonged treatment, which is unusual for healthy the kidneys. In terms of the specificity of the damage, there is a high probability that internal hemorrhage into the kidney tissue can begin, since the components of this biological filter are much thinner and more vulnerable than in other organs.
What are the damage?
As for the nature and severity of the injury, it is, of course, individually, and the limits of diagnosis and treatment can also be quite extensive. But, in practice, specialists have five relatively typical categories of damage, of which only the first two are the safest:
- In the first place in terms of prevalence are bruises and hematomas, which are peculiar to humans and can occur in any circumstances. At the same time, during diagnosis, it is important that a parenchyma rupture is not detected.
- Also a fairly common, but more complicated diagnosis is mechanical damage to the kidney cortex, not exceeding 10 mm in depth. In this case, a bruising in the renal region can be detected, but it is important that there are no bloody impurities in the urine.
- In the third paragraph, the conventions are the same, but the situation is complicated by a higher indicator of the depth of damage - from 10 mm.
- The presence of more serious injuries, which may be accompanied by serious complications. Here, the calyx and pelvis may be affected, and thrombosis of the artery area is not excluded.
- In the latter category, the situation will be the most complicated, damages or ruptures in the region of blood vessels and the circulatory system, as well as deep damage to the renal tissues and other undesirable indicators, are not excluded.
Pain is the main symptom of kidney injury.
The most frequent accompaniment of a kidney injury is a sharp specific pain in the lumbar region, which differs from any other types of pain and is felt for quite some time. If the injury is isolated, then its symptoms may not appear at all, but this is only in 5% of patients. If the injury is serious, then symptoms such as weakness throughout the body, pain in the lumbar and in the entire back, urine with blood, and frequent headache may occur.
Diagnostics
When diagnosing a kidney bruise, it is important what concomitant manifestations of malaise are present, it is important to find out if there is a blood impurity in the urine, and also there is swelling in the lumbar region. When massive blood loss is noticed, the patient appears characteristic pallor, tachycardia is also observed, nausea and vomiting are not excluded, as well as constant jumps in blood pressure. In this case, even with minimal deviations, all the symptoms are accompanied by violations in the urinary process.
The most difficult symptom of a kidney bruise is the presence of characteristic clots in the urine, which causes particular difficulties in terms of treatment, if after urination there are no signs, but other symptoms are clearly expressed, then the case is complex. It is equally important for the doctor to know the hemodynamic parameters, if it does not give a stable result, then the patient is scheduled for surgery, if the indicator is not variable, then they are preparing for further full examination.
Establishing diagnosis
In order to make a diagnosis, a specialist needs the following indicators: anamnesis, data from a laboratory and instrumental study, as well as the presence of concomitant symptoms, which were mentioned above. Diagnostic procedures are accompanied by the following tests that will be needed to make a correct diagnosis: a general urine test for hematuria, to eliminate anemia, a general blood test is needed and narrow-targeted urine tests can be prescribed for certain suspicions.
How to diagnose a more severe case?
Depending on the severity of the damage and, in general, the nature of the injury, the patient is sent for research using special instruments and instrumental methods, such as x-rays, ultrasound scans, cystoscopy, angiography and many others. In order to make a complete and accurate diagnosis, doctors rely on radiography, it contains the indicators of the general condition of the patient, it is also easier to locate the damage in the picture and check whether there are any bone fractures and fragments in the renal region, and injuries are not excluded in this case neighboring organs, as well as the occurrence of a hematoma in the retroperitoneal region. In order to obtain data specifically about the work of the kidneys, their blood supply system, as well as about changes in functioning, radiopaque studies are prescribed, they include angiography and radioisotope indicators.
Ultrasound for pathology
The simplest thing that can be prescribed, and in fact safe, is the scanning using ultrasound. In fact, this method can help in the study of serious injuries, but is used mainly in the early stages. Here you can find out how the structure of the parenchyma has changed, as well as where the hematoma is located, whether it can be localized. Although these methods are quite effective, they cannot always fully establish the nature of the damage, which makes conventional treatment ineffective.
Do I need to have surgery?
If the injury has not been fully studied, and the prescribed course of recovery does not bring results and deterioration is noticeable, then the patient is sent for surgery, sometimes urgently. Even if a person is not so noticeable deterioration after an injury, but there are even primary symptoms of kidney injury, it is necessary to minimize movement, especially sharp and, accordingly, find a competent specialist who will prescribe the appropriate treatment. There is such a thing as a subcapsular hematoma, that is, under the renal capsule hematoma is very closely visible, which can provoke a rupture of this very capsule. If this happens, then the patient’s condition will noticeably worsen and there will be a need for urgent hospitalization.
How is kidney injury treated ?
As already known, the treatment of symptoms of kidney bruising can vary and depends on many factors. Such as the degree and nature of the damage, disruption of the renal arteries and tissues, the presence of bloody discharge, as well as the presence of not only related injuries, but also diseases that can greatly inhibit the healing process. First of all, first aid is needed for a bruised kidney. If it was revealed that the bruise was mild, then the patient does not need serious drug therapy, further monitoring and procedures should be performed on an outpatient basis. If the severity can be attributed to the third category and higher, then the patient must stay in the hospital under the supervision of specialists.
Special attention is given to nutrition after a kidney injury. In this case, you must adhere to the diet at number five.
What are the main activities included in therapeutic treatment?
The list of treatment for kidney injury includes:
- The initial stage is cooling in the area of damage of any nature.
- Complete peace, body movements are minimized.
- Reduced daily dose of fluid intake, so as not to "strain" the injured organ.
- Prescribing physiotherapy and conducting it in accordance with the doctor's prescriptions.
- The use of painkillers, especially for serious injuries, there may be a simple analgesic, and the introduction of novocaine blockade.
Next steps
So that the patient does not suffer from increased bleeding, as well as to reduce hematuria, the lesion should be cooled, this must be done by the patient himself, who, after the blow, can also apply something cold. After a couple of days, sometimes even weeks, they resort to such procedures as electrophoresis, UHF therapy, thermal exposure, they are already aimed at resorption of the hematoma. If during the first days a person has constant and severe pain, then the most suitable painkillers are selected for him. In order to track the recovery process, you need to go through several more tests of urine and blood, as well as the radiography procedure, during these diagnostic studies, the dynamics of the restoration of the damaged area will be viewed.
It is important to know that delaying even the first time after an impact is very dangerous. Without a proper study of the injury, no one will be able to make a diagnosis, so it’s absolutely impossible to take the initiative into your own hands and choose treatment yourself. If the bruise was really severe, but deviations were not noticed, except for pain in the lumbar region, it is still worthwhile to make sure that the danger has passed, because often serious blows often do not appear in the form of familiar symptoms. Severe complications that are developing quite rapidly lead not only to a complex treatment process, but also to kidney removal and even death in completely neglected situations.