Injury - kidney and ureter Health Article

Signs and tests

A history of physical injury, exposure to potentially toxic substances, or recent infections or illness may show 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.

• Urinalysis may show blood. It may show sediment or crystals that show inflammation or toxic accumulations of uric acid or other substances. Part of the urinalysis is an RBC urine test. This may show increased red blood cells due to renal tumors, trauma, stones, or necrosis.
• CBC may show bleeding, infection, or inflammation. Other blood tests may reveal toxic levels of suspected substances.
• Electrolyte analysis of the blood may demonstrate increased potassium, urea, or creatinine.
• Kidney x-ray, abdominal CT scan, or abdominal MRI scan may show damage to the kidney.
• Renal scan may show problems with kidney blood flow.
• Angiography of the artery or vein may show occlusion of blood flow to or from the kidney.
• IVP (intravenous pyelogram) shows the functioning of the kidney. The IVP may be repeated after treatment of kidney injury to assess functioning of the traumatically injured kidney.

Treatment

Treatment goals include treatment of emergency symptoms and prevention or treatment of complications.

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.

Bleeding may be severe enough to require surgical removal of the entire kidney (nephrectomy) to control the bleeding. Surgical interventions to control bleeding may include drainage of the space around the kidney. Sometimes angio-embolization is utilized to stop the bleeding.

Surgical repair of a "fractured" or torn kidney, torn blood vessels, torn ureter, or similar injury may spare the kidney from removal. The timing of the surgical exploration depends on the location, the extent of injury, and the overall clinical situation.

For example, if an isolated ureteral injury is discovered 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.

Surgical removal or repair of clots or other obstructions may correct injury caused by damage to blood vessels or the ureter.

Nonsurgical treatment of external damage to the kidney may include bedrest for 1 to 2 weeks or until bleeding is reduced, narcotics for pain relief, and close observation and treatment for symptoms of kidney failure.

Exposure to substances, including medications that are suspected of causing injury to the kidney, should be stopped. This may require stopping or changing medications, or it may require a change in occupational or recreational habits. Many cases of toxic injury will reverse when exposure to the substance is stopped.

Some nephrotoxic substances have specific treatments to counteract them. For example, lead poisoning may be treated with chelation therapy, which involves the use of penicillamine, a medication that binds with the lead and allows it to be excreted from the body. Gout and other causes of uric acid accumulation may be treated with allopurinol or similar medications.

Injury caused by infection or inflammation should be treated as appropriate for the specific type of glomerulonephritis or acute tubular necrosis that develops. Treatment may include medications, such as corticosteroids, immunosuppressants, and others.

Treatment may also include dietary restrictions and treatment of acute kidney failure.

Expectations (prognosis)

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.

Complications

• Pain
• Renal hypertension (even if no other signs of renal failure)
• Infection of the urinary tract
• Infection of other areas (peritonitis, sepsis)
• Bleeding, minor
• Bleeding, severe (hemorrhage)
• Shock
• Acute renal failure, one or both kidneys
• Chronic renal failure, one or both kidneys
• Renal artery stenosis