High-grade renal trauma rarely occurs due to low-velocity mechanisms. With its clinical presentation, delayed diagnosis rarely happens. We report the case of a 12-year-old girl diagnosed seven days post-trauma with gr...High-grade renal trauma rarely occurs due to low-velocity mechanisms. With its clinical presentation, delayed diagnosis rarely happens. We report the case of a 12-year-old girl diagnosed seven days post-trauma with grade IV renal trauma complicated with infected urinoma and bilateral lower polar vessels. She was non-operatively managed with ultrasound-guided percutaneous drainage of the urinoma, which resolved, and had unremarkable six months follow-up. We discuss the role of preexistent hydronephrosis in low-velocity impact, pitfalls of diagnosis in resource-constrained settings, and management of high-grade trauma.展开更多
Renal injuries are classified,based on the American Association for the Surgery of Trauma classification,in to five grades of injury.Several imaging modalities have been available for assessing the grade of renal inju...Renal injuries are classified,based on the American Association for the Surgery of Trauma classification,in to five grades of injury.Several imaging modalities have been available for assessing the grade of renal injury,each with their usefulness and limitations.Currently,plain radiographs and intravenous urography have no role in the evaluation of patients with suspected renal injury.Ultrasonography(USG) has a limited role in evaluating patients with suspected retroperitoneal injury;however,it plays an important role during follow up in patients with urinoma formation.USG helps to monitor the size of a urinoma and also for the drainage procedure.The role of selective renal arteriography is mainly limited to an interventional purpose rather than for diagnostic utility.Retrograde pyelography is useful in assessing ureteral and renal pelvis integrity in suspected ureteropelvic junction injury and for an interventional purpose,like placing a stent across the site of ureteric injury.Magnetic resonance imaging has no role in acute renal injuries.Multidetector computed tomography is the modality of choice in the evaluation of renal injuries.It is also useful in evaluating traumatic injuries to kidneys with preexisting abnormalities and can help to define the extent of penetrating injuries in patients with stab wounds in the flank region.The combination of imaging findings along with clinical information is important in the management of the individual patient.This article will describe a spectrum of renal injuries encountered in a trauma setting.展开更多
We present a case of a pediatric patient with high grade renal injury following a minor fall,where clinical suspicion of occult injury resulted in diagnosis.Additionally,we review the management of high grade renal la...We present a case of a pediatric patient with high grade renal injury following a minor fall,where clinical suspicion of occult injury resulted in diagnosis.Additionally,we review the management of high grade renal lacerations in children,including the role of ultrasound in managing these injuries.展开更多
Background:After renal trauma,surgical treatment is vital,but sometimes there may be loss of function due to fibrosis.This study aimed to evaluate the effect of autologous omentum flaps on injured renal tissues in a r...Background:After renal trauma,surgical treatment is vital,but sometimes there may be loss of function due to fibrosis.This study aimed to evaluate the effect of autologous omentum flaps on injured renal tissues in a rat model.Methods:A total of 30 Wistar albino rats were included and randomly divided equally into a control group and four intervention groups.Iatrogenic renal injuries were repaired using a surgical technique(primary repair 1 group and primary repair 2 group)or transposition of the autologous omentum(omentum repair 1 group and omentum repair 2 group).Blood samples were taken preoperatively and on the 1st and 7th postoperative days in all groups and on the 18th postoperative day in the control and two intervention groups.All rats were sacrificed on the 7th or 18th day postoperatively,and their right kidneys were taken for histopathological evaluation.Results:The mean urea level significantly decreased from day 1 to day 7 and from day 1 to day 18 in the omentum repair 2 group(P=0.005 and P=0.004,respectively).There were no other significant changes in urea or creatinine levels within the intervention groups(P>0.05).There was no significant correlation between the urea and creatinine levels and the histological scores(P>0.05).The primary repair 1 and 2 groups had significantly higher median granulation and inflammation scores in the kidney specimen than the control and omentum repair groups(P<0.05).The omentum repair 2 group had significantly lower median granulation and inflammation scores in the surrounding tissues than the primary repair 2 group(P<0.05).The completion score for the healing process in the kidney specimen was significantly higher in the omentum repair groups than in the primary repair groups(P<0.05).The omentum repair 2 group had significantly lower median granulation and inflammation scores in the surrounding tissues than the primary repair 2 group(P<0.05).Granulation degree in the kidney specimen was strongly and positively correlated with the inflammation degree(r=0.824,P<0.001)and foreign body reaction in the kidney specimen(r=0.872,P<0.001)and a strong and negative correlation with the healing process completion score in the kidney(r=−0.627,P=0.001).Inflammation degree in the kidney specimen was strongly and positively correlated with the foreign body reaction in the kidney specimen(r=0.731,P=0.001)and strongly and negatively correlated with the healing process completion score in the kidney specimen(r=−0.608,P=0.002).Conclusion:Autologous omentum tissue for kidney injury repair attenuated inflammation and granulation.Additionally,the use of omental tissue to facilitate healing of kidney injury may theoretically lead to a more effective healing process and reduced fibrosis and tissue and function loss.展开更多
Objective:The aim of this study was to evaluate the predictor of unsuccessful outcome of renal angioembolization(RAE).Knowing those predictors may help in avoiding unnecessary RAE procedures and their associated side ...Objective:The aim of this study was to evaluate the predictor of unsuccessful outcome of renal angioembolization(RAE).Knowing those predictors may help in avoiding unnecessary RAE procedures and their associated side effects,while helping to prepare for an alternate procedure and improving patient's overall satisfaction.Methods:A retrospective analysis between January 2006 and December 2018 was performed,and the indications for RAE were classified into post-traumatic,iatrogenic,renal tumors,and spontaneous.Patients who underwent RAE prior to nephrectomy were eliminated.Computed tomography angiography was performed in patients with normal renal function and those who had no contrast allergy,otherwise magnetic resonance angiography was performed.For the purpose of statistical analysis,we stratified patients into two main categories based on the final outcome—successful or failed.Results:Of 180 patients,32 with negative angiography were eliminated,leaving 148 patients;136(91%)had successful outcomes after one or more trials and 12 had unsuccessful outcomes.The mean age was 45±15 years,and 105(71%)were male.Neither gender,side of the lesion,presence of hematuria,indication for RAE,nor the type of lesion affected the outcome.On the other hand,renal anatomy with presence of accessory artery was the only predictor to failed RAE(p=0.001).Failed RAE trial was a predictor for nephrectomy as a secondary procedure(p=0.03).Conclusion:No pre-procedural predictors could anticipate the RAE outcome,and different indications can be scheduled to RAE,which is equally effective.The presence of accessory renal artery on diagnostic angiography is the only factor that may predict the failure of the procedure.展开更多
文摘High-grade renal trauma rarely occurs due to low-velocity mechanisms. With its clinical presentation, delayed diagnosis rarely happens. We report the case of a 12-year-old girl diagnosed seven days post-trauma with grade IV renal trauma complicated with infected urinoma and bilateral lower polar vessels. She was non-operatively managed with ultrasound-guided percutaneous drainage of the urinoma, which resolved, and had unremarkable six months follow-up. We discuss the role of preexistent hydronephrosis in low-velocity impact, pitfalls of diagnosis in resource-constrained settings, and management of high-grade trauma.
文摘Renal injuries are classified,based on the American Association for the Surgery of Trauma classification,in to five grades of injury.Several imaging modalities have been available for assessing the grade of renal injury,each with their usefulness and limitations.Currently,plain radiographs and intravenous urography have no role in the evaluation of patients with suspected renal injury.Ultrasonography(USG) has a limited role in evaluating patients with suspected retroperitoneal injury;however,it plays an important role during follow up in patients with urinoma formation.USG helps to monitor the size of a urinoma and also for the drainage procedure.The role of selective renal arteriography is mainly limited to an interventional purpose rather than for diagnostic utility.Retrograde pyelography is useful in assessing ureteral and renal pelvis integrity in suspected ureteropelvic junction injury and for an interventional purpose,like placing a stent across the site of ureteric injury.Magnetic resonance imaging has no role in acute renal injuries.Multidetector computed tomography is the modality of choice in the evaluation of renal injuries.It is also useful in evaluating traumatic injuries to kidneys with preexisting abnormalities and can help to define the extent of penetrating injuries in patients with stab wounds in the flank region.The combination of imaging findings along with clinical information is important in the management of the individual patient.This article will describe a spectrum of renal injuries encountered in a trauma setting.
文摘We present a case of a pediatric patient with high grade renal injury following a minor fall,where clinical suspicion of occult injury resulted in diagnosis.Additionally,we review the management of high grade renal lacerations in children,including the role of ultrasound in managing these injuries.
基金the Acıbadem Mehmet Ali Aydınlar University under Grant 2018-03-05.
文摘Background:After renal trauma,surgical treatment is vital,but sometimes there may be loss of function due to fibrosis.This study aimed to evaluate the effect of autologous omentum flaps on injured renal tissues in a rat model.Methods:A total of 30 Wistar albino rats were included and randomly divided equally into a control group and four intervention groups.Iatrogenic renal injuries were repaired using a surgical technique(primary repair 1 group and primary repair 2 group)or transposition of the autologous omentum(omentum repair 1 group and omentum repair 2 group).Blood samples were taken preoperatively and on the 1st and 7th postoperative days in all groups and on the 18th postoperative day in the control and two intervention groups.All rats were sacrificed on the 7th or 18th day postoperatively,and their right kidneys were taken for histopathological evaluation.Results:The mean urea level significantly decreased from day 1 to day 7 and from day 1 to day 18 in the omentum repair 2 group(P=0.005 and P=0.004,respectively).There were no other significant changes in urea or creatinine levels within the intervention groups(P>0.05).There was no significant correlation between the urea and creatinine levels and the histological scores(P>0.05).The primary repair 1 and 2 groups had significantly higher median granulation and inflammation scores in the kidney specimen than the control and omentum repair groups(P<0.05).The omentum repair 2 group had significantly lower median granulation and inflammation scores in the surrounding tissues than the primary repair 2 group(P<0.05).The completion score for the healing process in the kidney specimen was significantly higher in the omentum repair groups than in the primary repair groups(P<0.05).The omentum repair 2 group had significantly lower median granulation and inflammation scores in the surrounding tissues than the primary repair 2 group(P<0.05).Granulation degree in the kidney specimen was strongly and positively correlated with the inflammation degree(r=0.824,P<0.001)and foreign body reaction in the kidney specimen(r=0.872,P<0.001)and a strong and negative correlation with the healing process completion score in the kidney(r=−0.627,P=0.001).Inflammation degree in the kidney specimen was strongly and positively correlated with the foreign body reaction in the kidney specimen(r=0.731,P=0.001)and strongly and negatively correlated with the healing process completion score in the kidney specimen(r=−0.608,P=0.002).Conclusion:Autologous omentum tissue for kidney injury repair attenuated inflammation and granulation.Additionally,the use of omental tissue to facilitate healing of kidney injury may theoretically lead to a more effective healing process and reduced fibrosis and tissue and function loss.
文摘Objective:The aim of this study was to evaluate the predictor of unsuccessful outcome of renal angioembolization(RAE).Knowing those predictors may help in avoiding unnecessary RAE procedures and their associated side effects,while helping to prepare for an alternate procedure and improving patient's overall satisfaction.Methods:A retrospective analysis between January 2006 and December 2018 was performed,and the indications for RAE were classified into post-traumatic,iatrogenic,renal tumors,and spontaneous.Patients who underwent RAE prior to nephrectomy were eliminated.Computed tomography angiography was performed in patients with normal renal function and those who had no contrast allergy,otherwise magnetic resonance angiography was performed.For the purpose of statistical analysis,we stratified patients into two main categories based on the final outcome—successful or failed.Results:Of 180 patients,32 with negative angiography were eliminated,leaving 148 patients;136(91%)had successful outcomes after one or more trials and 12 had unsuccessful outcomes.The mean age was 45±15 years,and 105(71%)were male.Neither gender,side of the lesion,presence of hematuria,indication for RAE,nor the type of lesion affected the outcome.On the other hand,renal anatomy with presence of accessory artery was the only predictor to failed RAE(p=0.001).Failed RAE trial was a predictor for nephrectomy as a secondary procedure(p=0.03).Conclusion:No pre-procedural predictors could anticipate the RAE outcome,and different indications can be scheduled to RAE,which is equally effective.The presence of accessory renal artery on diagnostic angiography is the only factor that may predict the failure of the procedure.
