Injury of the kidney and ureter

Causes and Risks:
The kidneys are located in the back of the upper abdomen at either side of the spinal column. They are deep within the abdomen from the front and are protected in the back by the spine, lower rib cage, and the strong muscles of the back. This location protects them from external forces, so injury from external sources is uncommon. However, it may occur with athletic injury, occupational injury, or from traumatic accidents.

The kidneys are highly vascular organs. They may be injured from damage to the blood vessels that supply or drain them, such as may occur with arterial occlusion or renal vein thrombosis . Kidneys may also bleed profusely if they are damaged. The most common result of kidney injury from external force is bruising of the kidney, which is self contained and heals spontaneously. The most dangerous result of kidney damage from external force is bleeding , which can be profuse and life threatening.

Each kidney filters about 1700 liters of blood per day and concentrates fluid and waste products into about 1 liter of urine per day. Because of this, the kidneys receive more exposure to toxic substances in the body than almost any other organ; therefore, they are highly susceptible to injury from toxic substances. Analgesic nephropathy is one of the most common types of toxic damage to the kidney. Exposure to lead, cleaning products, solvents, fuels, or other nephrotoxic chemicals (those which can be toxic to the kidney) can damage kidneys. Excessive build-up of body waste products such as uric acid (that can occur with gout or with treatment of bone marrow, lymph node, or other disorders) can also damage the kidneys.

Inflammation from immune response to medications, infection, or disorders may also injure the structures of the kidney, usually causing various types of glomerulonephritis or acute tubular necrosis (tissue death).

Injury to the kidney may result in short-term damage with minimal or no symptoms. It may also be life threatening from bleeding and associated shock , or it may result in acute renal failure or chronic renal failure .

Prevention:
External damage may be prevented by using general safety precautions--using appropriate safety equipment during work and play, wearing seat belts and driving safely.

Toxic injury often may be prevented by properly observing the directions for use of the medication or product. Follow the directions of the health care provider for use of all medications, including over-the-counter medications. Use cleaning products, solvents, and fuels as directed, in a well-ventilated area, because the fumes may also be toxic. Be aware of potential sources of lead poisoning , such as old paints, vapors from working with lead coated metals, alcohol distilled in recycled car radiators, and similar sources.

Follow the instructions of the health care provider for the treatment of gout and other illnesses.

Symptoms:
Acute or emergency symptoms:

Chronic symptoms:



Signs and Tests:
A history of physical injury, exposure to potentially toxic substances, or recent infections or illness may indicate the source of injury to the kidney. If there is loss of blood, examination by touch ( palpation ) may reveal extreme tenderness over the kidney. There may be signs of hemorrhage and shock , including rapid heart rate and falling blood pressure . Toxic injury or injury from inflammation may cause acute or chronic renal failure .

  • A urinalysis may show blood. It may show sediment or crystals that indicate inflammation or toxic accumulations of uric acid or other substances. Part of the urinalysis is an RBC urine test. This may indicate increased red blood cells due to renal tumors, trauma, stones, or necrosis .
  • A CBC may indicate bleeding , infection, or inflammation. Other blood tests may reveal toxic levels of suspected substances.
  • Kidney X-ray , abdominal CT scan , or abdominal MRI scan may show damage to the kidney.
  • A renal scan may indicate problems with kidney blood flow.
  • An angiography of the artery or vein may show occlusion of blood flow to or from the kidney.
  • An IVP ( intravenous pyelogram ) may reveal functioning of the kidney. The IVP may be repeated after treatment of kidney injury to assess functioning of the traumatically injured kidney.



Treatment:
Treatment goals include treatment of emergency symptoms and prevention or treatment of complications. Most cases of external trauma result in mild bruises that heal spontaneously. Analgesics may be needed for pain relief. Hospitalization and close observation may be required because of the risk of internal loss of blood from a traumatically injured kidney.

Approximately 20% of cases of external damage require emergency surgery because of bleeding problems. Bleeding may be severe enough to require surgical removal of the entire kidney ( nephrectomy ) to control the bleeding. Surgical interventions to control bleeding may include drainage of the space around the kidney.

Surgical repair of a "fractured" or torn kidney, torn blood vessels, torn ureter, or similar injury may spare the kidney from removal. The kidney may return to normal function, or it may experience acute or chronic failure. If only one kidney is affected, there may be no symptoms from the failed kidney, because the second (healthy) kidney takes over functioning.

Surgical removal or repair of clots or other obstructions may correct injury caused by damage to blood vessels or the ureter.

Nonsurgical treatment of external damage to the kidney may include bedrest for 1 to 2 weeks or until bleeding is reduced, narcotics for pain relief, and close observation and treatment for symptoms of kidney failure .

Exposure to substances, including medications that are suspected of causing injury to the kidney should be stopped. This may require stopping or changing medications, or it may require a change in occupational or recreational habits. Many cases of toxic injury will reverse when exposure to the substance is stopped.

Some nephrotoxic substances have specific treatments to counteract them. For example, lead poisoning may be treated with chelation therapy, which involves the use of penicillamine, a medication that binds with the lead and allows it to be excreted from the body. Gout and other causes of uric acid accumulation may be treated with allopurinol or similar medications.

Injury caused by infection or inflammation should be treated as appropriate for the specific type of glomerulonephritis or acute tubular necrosis that develops. Treatment may include medications such as corticosteroids, immunosuppressants, and others.

Treatment may also include dietary restrictions and treatment of acute kidney failure .

Prognosis:
The outcome varies depending on the cause and extent of injury. The damage may be mild and reversible, or it may be immediately life threatening, or it may be prolonged and result in complications.

Complications:



Call Your Healthcare Provider:
Call your health care provider if symptoms indicate injury to the kidney or ureter, especially if there is a history of physical injury, exposure to potentially toxic substances, illness, or infection.

Go to the emergency room or call the local emergency number (such as 911) decreased urine output develops after kidney injury, this may be an emergency symptom indicating kidney failure .


The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and the stimulation of red blood cell production. The gross anatomical structure of the kidney is illustrated.



This is the typical appearance of the blood vessels (vasculature) and urine flow pattern in the kidney. The blood vessels are shown in red and the urine flow pattern in yellow.