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Management of Kidney and Ureter Injuries

  • Eric H. BradburnEmail author
  • Madison Morgan
  • Danielle Von Nieda
Chapter

Abstract

Acute kidney injury (AKI) is characterized by a sudden deterioration in kidney function. Clinical diagnosis of AKI is based on serum creatinine levels, urine output, and abdominal or flank tenderness or bruising. Hemodynamic stability is determined after vital signs are obtained and a physical examination is performed. A stable patient suspected to have an AKI may have further analysis of blood work completed, as well as diagnostic imaging such as a computerized axial tomography (CT) scan to determine what further actions are necessary based on the grade of the injury. If the patient is hemodynamically unstable, immediate surgical intervention such as a laparotomy is required to determine the mechanism of injury and plan of treatment. After treatment is received, appropriate follow-up care is recommended. AKIs are becoming more common, whereas injury to the ureter continues to be very uncommon. Flank pain, penetrating injury to the abdomen, or recent surgery are indicative of ureter injury. If the injury to the ureter is detected initially, hemodynamic stability should be the next variable considered. If the patient is hemodynamically stable, a CT scan should be performed to diagnose the injury. If the patient is not stable, immediate surgical intervention is needed. Oftentimes, ureter injury is not detected upon initial examination. In this scenario, ultrasonography should be performed, and the necessary procedures should occur. Following these procedures, if symptoms persist, exploratory surgery is recommended.

Keywords

Acute kidney injury Ureter Kidney grades Renal injury Globular filtration rate Creatinine Hematuria Laparotomy Genitourinary Extravasation Penetrating trauma Urinoma 

References

  1. 1.
    Moore EE, Cogbill TH, Malangoni M, Jurkovich GJ, Champion HR. Injury scoring scale: a resource for trauma care professionals: The American Association for the Surgery of Trauma; 2017. http://www.aast.org/Library/TraumaTools/InjuryScoringScales.aspx
  2. 2.
    Khwaja A. KDIGO clinical practice guideline for acute kidney injury. Nephron Clin Pract. 2012;120(4):179–84.Google Scholar
  3. 3.
    Kalantarinia K. Novel imaging techniques in acute kidney injury. Curr Drug Targets. 2009;10(12):1184–9.CrossRefGoogle Scholar
  4. 4.
    Rahman M, Shad F, Smith M. Acute kidney injury: a guide to diagnosis and management. Am Fam Physician. 2012;86(7):631–9.PubMedGoogle Scholar
  5. 5.
    Zinman LN, Vanni AJ. Surgical Management of Urologic Trauma and Iatrogenic Injuries. Surg Clin North Am. 2016;96(3):425–39.CrossRefGoogle Scholar
  6. 6.
    Teber D, Egey A, Gozen AS, Rassweiler J. Ureteral injuries. Diagnostic and treatment algorithm. Urologe A. 2005;44(8):870–7.CrossRefGoogle Scholar
  7. 7.
    Asali MG, Romanowsky I, Kaneti J. External ureteral injuries. Harefuah. 2007;146(9):686–9, 734.PubMedGoogle Scholar
  8. 8.
    Siram SM, Gerald SZ, Greene WR, Hughes K, Oyetunji TA, Chrouser K. Ureteral trauma: patterns and mechanisms of injury of an uncommon condition. Am J Surg. 2010;199(4):566–70.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Eric H. Bradburn
    • 1
    Email author
  • Madison Morgan
    • 1
  • Danielle Von Nieda
    • 1
  1. 1.Department of Trauma and Acute Care SurgeryPenn Medicine Lancaster General HealthLancasterUSA

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