INJURIES TO KIDNEY

Commonly, it is due to a blunt injury. Often it is associated with other abdominal injuries—of liver, spleen, bowel, mesentery, etc. renal injury is extraperitoneal.

TYPES

1. Small subcapsular.
2. Large subcapsular.
3. Cortical laceration.
4. Laceration with perinephric haematoma.
5. Medullary laceration with bleeding into the renal pelvis.
6. Corticomedullary complete rupture.
7. Hilar injury (most dangerous).

CLINICAL FEATURES

• Features of shock.
• Haematuria—may be mild to profuse depending on the
• type of injury.
• Sudden delayed profuse haemorrhage causing haematuria can occur between 3rd day to 3rd week after trauma.
• Clot colic.
• Bruising, swelling and tenderness in the loin.
• Paralytic ileus with abdominal distension occurs due to
• retroperitoneal haematoma implicating splanchnic nerves

INVESTIGATIONS

• CT scan is the investigation of choice. It gives the grading of the renal injury; identifies the associated injuries; gives idea about the function of the kidney reasonably.
• Ultrasound abdomen is also important initial tool to identify the site and type of injuries, haemoperitoneum and associated injuries. It is very useful tool to check the response for conservative therapy by repeating it at regular intervals.
• IVU is also useful to see the function of the injured kidney as well as opposite kidney. This may lead into uraemia with raised blood urea and serum creatinine and often needs haemodialysis for few times.
• Renal function tests
• serum electrolyte estimation
• haematocrit assessment
• blood grouping.
• Chest X-ray
• CT scan chest
• plain X-ray abdomen

COMPLICATIONS

• Clot retention in the bladder and may go for renal failure
• Pararenal pseudohydronephrosis
• Infection
• Perinephric abscess
• Aneurysm of the renal artery
• Renal failure
• Hypertension occurs 3 months later.

HOMOEOPATHIC MANAGEMENT:

• ARNICA MONT
• CONIUM
• HYPERICUM
• LACHESIS
• SERUM ANGULLAE
• CUPRUM SRS
• AMPELOPSIS