Management of Kidney and Ureter Injuries
Acute kidney injury (AKI) is characterized by a sudden deterioration in kidney function. Clinical diagnosis of AKI is based on serum creatinine levels, urine output, and abdominal or flank tenderness or bruising. Hemodynamic stability is determined after vital signs are obtained and a physical examination is performed. A stable patient suspected to have an AKI may have further analysis of blood work completed, as well as diagnostic imaging such as a computerized axial tomography (CT) scan to determine what further actions are necessary based on the grade of the injury. If the patient is hemodynamically unstable, immediate surgical intervention such as a laparotomy is required to determine the mechanism of injury and plan of treatment. After treatment is received, appropriate follow-up care is recommended. AKIs are becoming more common, whereas injury to the ureter continues to be very uncommon. Flank pain, penetrating injury to the abdomen, or recent surgery are indicative of ureter injury. If the injury to the ureter is detected initially, hemodynamic stability should be the next variable considered. If the patient is hemodynamically stable, a CT scan should be performed to diagnose the injury. If the patient is not stable, immediate surgical intervention is needed. Oftentimes, ureter injury is not detected upon initial examination. In this scenario, ultrasonography should be performed, and the necessary procedures should occur. Following these procedures, if symptoms persist, exploratory surgery is recommended.
KeywordsAcute kidney injury Ureter Kidney grades Renal injury Globular filtration rate Creatinine Hematuria Laparotomy Genitourinary Extravasation Penetrating trauma Urinoma
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