KIDNEY URETER renal trauma grades of injury treat

 RENAL TRAUMA

Injury  to the kidney are classified as mild-moderate and  severe

moderate injuries will have tear of parenchyma......... and  extending

to tear of capsule. Damiage to the pedicle occurs nephrectomy  is

required IVP and angiography are important to devine severly mild

and modrate injurues can be managed by conservative therapy of :

        -       blood transfussion

        -       bed rest

        -       antibiotics

        -       care monitoring of rital signs.

Surgery through a transperitoneal approach may be required in case

of failure of conservative therapy.

Penetrating  injuries due to sharp instrument in stab  wounds  or

gunshots  if patients condition allows an accurate diagnosis  can

be  obtained  by  IVP.   Most severe  injuries  will  require  an

exploration  to repair and prevent future arterio venous  fistula

formation. Fig.25.8

Blunt injuries to the abdomen and back can also result in  injury

to  the  kidney.  Patient  presents  with  microscopic  or   frank

haematuria.   Patient   may  also  have  loin  pain,   lump   and

hypotension.  A  urogram will give information on the  extent  of

injury.  Patient  of  severe injury to  the  renal  pedicle  will

require surgery and a nephrectomy.

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KIDNEY URETER CONGENITAL Anomalies

CONGENITAL ANOMALIES OF KIDNEY

These are :

a. Unilateral agenesis (absence of kidney on one side)Fig. 25.4

b. Supernumery kidney (more than two)

c. This is a rare occurrence and the renal tissue lies below  the

   normal  kidney  it is of no importance.  Ectopic  (present  in

   pelvis) Fig. 25.5

d. Crossed ectopic both on one side Fig. 25.6

e. Nephroptosis (mobile kidney)

f. Horse-shoe kidney (kidneys joined at one pole Fig. 25.7)

g. Cystic disease (solitary or multiple cysts)

An anomalous kidney can present with urinary infection since  the

drainage  system  may not be adequately develped, they  may  also

present with haematuria as a consequence.

Some of the conditions that need to be discussed further for they

present clinical problem are :

Unilateral  agenesis  occurs 1 in 1200 births  and  is  important

since the patient has only one functioning kidney. On no account,

can  nephrectomy be undertaken. Sometimes, the other  functioning

kidney can show hypertrophy and become palpable or there may also

be a mild ache.

Nephrotptosis   (mobile  kidney)  can  sometimes   present   with

intermittent  obstruction  giving rise to  repeated  pain,  lump,

fever  and  vomiting  (Deitl's Crisis),  the  lump  and  symptoms

disappear equally rapidly accompanied with polyuria.

Polycystic  disease  of the kidney can present later on  in  life

adult  with  unilateral or bilateral renal masses  and  signs  of

renal  failure. They can also present with Haematuria,  infection

and calculus disease.

The  cause  of  polycystic  disease is not known  but  may  be  a

developmental anomaly due to a n autosomal dominant gene probably

continuity between the nephron and the collecting tubules is  not

established.  The cyst on enlarging enterferes with the  function

of  the  adjoining  functioning nephrons. It is  the  third  most

common cause of renal failure.

Treatment  is non-surgical and is aimed at reducing  the  protein

load  in  the diet and control of infection. Patient  in  failure

require dialysis and transplant of kidney.

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KIDNEY URETER newer investigations 3

 NEWER TECHNIQUES

4.1 Ultrasound Scan (U.S)

This is a non-invassive investigation and has to a large  extent,

replaced radiologic tests in obtaining information regarding  the

kidney.  This  scan can be of renal failure can  tell  difference

between  solid  and  cystic lesions. Transrectal  U.S.  can  give

information of size of prostate.

4.2 Computerized Tomography (C.T.)

Especially  required for assessment of the  retroperitoneium  and

eliminating  the possibility of adrenal tumours  in  differential

diagnosis of flank masses.

This scan is used in cases of renal tumour to identify renal vein

involvement. It is also usefull for accurate staging of tesicular

tumours.

4.3 Arteriograms

This  test is less often used, since information can be  obtained

by ultrasound and C.T. scans. Information regards vascularity  of

the  lesion  can be had with this test. It can be  of   value  in

renal trauma cases.

In very vascular lesions, embolisation of the tumour vessels  can

also be done.

4.4 Radioisotopic Studies

Radioisotopic  labelled substances (DTPA, hippuran)  excreted  by

the  glomerulus  or  tubules provide a  functional  scan  of  the

kidney.  Information on relative function of different  areas  of

the kidney can be obtained.

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KIDNEY URETER Investigations 2 imaging

3 Imaging and Radiologic Investigation

3.1  Plain  X-ray  abdomen  (KUB)  can  reveal  kidney   outlines

secondaries in the vertefra in case of malignancies and stones in

the Urinary tract.

3.2  Intravenous  pylography  (IVP) with the  injection  (IV)  of

Urografin  (Fig. 25.3)

It  outlines the collecting system, pelvis, ureter  and  bladder.

Film are taken at 5,15 and 36mm after injection.

3.3 RETROGRADE PYLOGRAM

When  information  of  the upper urinary  tract  (Pelvis,  calyx,

ureter)  is  incomplete  after  an  IVP,  this  investigation  is

indicated. Dye is infected throug a aretrec catheter.

3.4 MICTURATING CYSTOURETHROGRAM

Studies  of  function of the bladder and urethra and  also  shows

reflux into the ureter. This is done by introducing dye into  the

bladder and asking the patient to micturate.

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