- What causes kidney injuries?
- Kidney laceration symptoms, signs, diagnosis, and stages
- Lacerated kidney treatment, complications, and recovery time
Playing in the National Football League (NFL) is like surviving a series of car wrecks, with each play and hit potentially causing significant injury. Most players absorb a tackle or block and walk away, but sometimes forces align and the body breaks. For Andrew Luck, Indianapolis Colts quarterback, those forces aligned in the fourth quarter of the game against the Denver Broncos, and a blow to his back when being tackled led to a laceration of his kidney. He continued to complete the game, but that is a testament for a mind fueled by the adrenaline of the situation that can overcome a body's pain and injury for a short period of time.
What causes kidney injuries?
A direct blow to the back most commonly causes kidney injuries. The kidneys (there are usually two, one on each side) are located in the flank, the area on the side and back of the abdomen just below the ribs. The kidneys are suspended by two connections to the rest of the body, the vascular pedicle that contains the arteries and veins that connect it to the aorta, and the ureter, that drains urine into the bladder. It is reasonably well protected by lower ribs, muscles, and fat of the body, but blunt force can cause the kidney to bruise (contusion) or break (termed a laceration or a bursting like a dropped watermelon). A kidney is divided into segments or poles so that each segment has its own blood supply and their urine drainage collects into the main ureter. This is helpful when the kidney is injured, since an injury to one part or segment does not doom the whole kidney.
Kidney laceration symptoms, signs, diagnosis, and stages
The diagnosis of a kidney laceration can often be missed initially if there isn't a high index of suspicion based on the mechanism of injury (usually a direct blow and often due to car accidents or other significant trauma). It's easier to detect if the patient has gross blood in the urine, but sometimes, there are only a few red blood cells in the urinalysis seen under a microscope. There should be abdominal pain or flank pain and tenderness when the flank is palpated (felt by the health-care provider during a physical exam). Kidney injuries also cause nausea and vomiting, and without the story of injury, the diagnosis can be missed. However, a CT scan of the abdomen can visualize the kidney structures, including the arteries and blood supply, and confirm a kidney laceration; sometimes an aortogram is needed to closely examine the kidney's blood supply.
There are variety of stages of kidney injury depending upon how much damage it sustained. It can be as mild as a bruise of the kidney that causes minimal damage (stage 1) or the kidney can be shattered and torn from its pedicle (stage 5). A lacerated kidney describes a literal tear of the kidney tissue that may or may not cause urine to leak where it doesn't belong.
Lacerated kidney treatment, complications, and recovery time
Because of its rich blood supply, the kidney is responsible for cleansing waste products from the body. A shattered kidney can be life-threatening and might need emergency surgery. Often, though, treatment is watchful waiting as the body allows the kidney to heal itself. Surgery is no longer routine, and patients with kidney injuries are treated with rest. If there is some bleeding, interventional radiology can clot off bleeding arteries and preserve the remaining uninjured kidney.
Healing is measured in weeks, and if no surgery is required, the victim can return to a regular life and function. There are potential complications. Early problems after injury can include delayed bleeding (usually within the first two weeks), infections, and urine leakage outside the kidney (urinomas). As well, hypertension may occur transiently because the kidney houses hormones and chemicals that help control blood pressure. There are late complications where scarring caused by the damage causes urine to drain abnormally, causing the kidney to swell and stones to form. There can be recurrent infection and delayed-onset high blood pressure. The average time to heal is about six weeks; with minor lacerations, healing may occur even faster. Severe lacerations that may require surgery will require more time to heal.
Medicine is slowly learning that sometimes, if left to its own devices and provided the proper support, the body can heal itself reasonably well. The kidney is an organ that is a testament to that observation.
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Morey, A.F., et al. "Urotrauma: AUA Guideline." J Urol 192.2 Aug. 2014.