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    Blunt Renal Trauma – Diagnosis & Treatment


    Last Updated Jun 20, 2022
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    • Renal trauma can occur in 10-20% of abdominal trauma in adults and children. 1
    • Mechanism of injury:
      • Blunt trauma 90%2: rapid deceleration or direct force.
      • Penetrating trauma 10%.2
      • Associated injuries:
        • Abdominal injuries, commonly liver or spleen.
        • Lower rib fractures.

    Diagnostic Process

    Clinical Manifestations:3

    • Hematuria
      • Degree of hematuria does not predict injury severity and may be absent.
    • Flank ecchymosis.
    • Fractured lower ribs.


    • When to obtain imaging1:
      • Penetrating trauma near the kidney.
      • Blunt trauma with:
        • gross hematuria.
        • microhematuria (>5 RBC per high power field) and hemodynamic instability.
        • no hematuria but high index of suspicion based on mechanism.
    • Imaging modality1:
      • CT abdomen with contrast with delayed urographic phase: allows for grading injury.
      • Ultrasound not generally recommended for diagnosis.

    Renal Injury Grading System 

    Recommended Treatment

    • Consult urology.
    • If hemodynamically stable
      • Blunt trauma
        • Initial nonoperative management is recommended for all injury grades.1
      • Penetrating trauma
        • Initial nonoperative management may be possible for low grade (grade I, II, III) injury with the following1:
          • Absence of major blood loss.
          • Absence of major renal parenchymal injury.
          • Absence of renal vascular injury.
          • Absence of associated intra-abdominal injury.
    • Nonoperative management: observation with supportive care, bed rest, and reimaging as needed.3
    • Surgery is recommended for
      • Hemodynamically unstable.
      • Penetrating injury with active bleeding.

    Quality Of Evidence?


    • High quality evidence for classification of the injury with CT scan with intravenous contrast and delayed urographic phase. 1

    Strong recommendation, moderate quality of evidence for nonoperative management for hemodynamically stable or stabilized minor, moderate, and severe lesions. 1


    Related Information

    Reference List

    1. Coccolini, Federico et al. “Kidney and uro-trauma: WSES-AAST guidelines.” World journal of emergency surgery : WJES 14 54. 2 Dec. 2019, doi:10.1186/s13017-019-0274-x

    2. Voelzke, Bryan B, and Laura Leddy. “The epidemiology of renal trauma.” Translational andrology and urology 3,2 (2014): 143-9. doi:10.3978/j.issn.2223-4683.2014.04.11

    3. Erlich, Tomer, and Noam D Kitrey. “Renal trauma: the current best practice.” Therapeutic advances in urology vol. 10,10 295-303. 10 Jul. 2018, doi:10.1177/1756287218785828


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