Traumatic lesions of the kidney

Abstract

Forty-five patients who had rupture of the kidney were studied. The majority of them were young adult males. Only those cases were considered in which the kidney was ruptured by external violence without penetration of the skin. The type of renal injury varied from slight subcapsular hemorrhage to complete pulpefaction of the kidney. In some cases the ureter or renal pedicle was completely avulsed. Hemorrhage, usually perirenal, but occasionally intraperitoneal, was uniformly present, and hematuria, either gross or microscopic, occurred in 95 per cent of the cases. Leakage of urine around the kidney was common. Serious associated injuries elsewhere in the body were present in 13.3 per cent of cases. Healing may occur satisfactorily with medical treatment, or on the other hand urinary fistulas, hydronephrosis, pseudohydronephrosis, pyelonephritis, or anatomic abnormalities of varying degrees may persist or develop. A history of trauma and hemorrhage and pain are cardinal points in the diagnosis, but they should also be substantiated by intravenous urography. In general, medical treatment immediately following the injury is preferred unless contraindicated. In certain cases in which patients are treated medically, subsequent operation may become necessary. The two deaths that occurred in this series of forty-five patients were attributed to severe extrarenal trauma. Thirty-one patients were followed for a period of from four to twenty-six years following injury. Eleven patients who underwent nephrectomy are entirely free of symptoms; 73.7 per cent of those treated medically are entirely well, and the remainder of this group have mild symptoms referable to the urinary tract.