Conservative treatment of renal rupture

The kidneys are the main organs that control a person's urinary function and blood. If a kidney ruptures, the consequences are unimaginable. However, due to the relatively sound external protective mechanism of the kidney, kidney rupture is relatively rare. When a person's kidney ruptures, it mainly refers to rupture of the renal tubules and other organs in the kidney. So what kind of conservative treatment should be adopted for kidney rupture?

What are the dangers of kidney rupture?

Renal rupture refers to rupture of the kidney that occurs in the presence of injury or non-injury, including rupture of the renal parenchyma, renal pelvis, and renal blood vessels. It is often secondary to pathological kidney and is relatively rare in clinical practice.

The kidneys are deeply hidden in the renal fossa and are well protected by the surrounding structures: behind the kidneys are the ribs, spine and long muscles of the back, in front are the abdominal wall and abdominal contents, and above are covered by the diaphragm. Normal kidneys have a mobility of 1 to 2 cm, so they are not easily damaged. But from another perspective, the posterior bone structure can also cause kidney damage. For example, the broken ends of the lower rib fractures can penetrate into the renal parenchyma; the kidneys are squeezed between the spine and its transverse processes and damaged.

A ruptured kidney is definitely a very serious condition. The kidney controls some of the body's excretion functions. If it ruptures, the body's metabolic function will be greatly affected and harmed. The consequences of renal rupture and massive bleeding include peritonitis, hematoma, hemorrhagic shock, and potentially life-threatening conditions.

treat

1. Prevent and treat shock

Regardless of whether there is shock or not, an infusion channel should be established as soon as possible upon admission to the hospital, sedation and analgesia should be given, and the patient should rest in bed. Those who are in shock are usually seriously injured. While fighting shock, you should also promptly check to determine the extent of the injury and give appropriate treatment as appropriate.

2. Non-surgical treatment

Suitable for renal contusion or mild laceration. Including absolute bed rest, anti-infection, application of hemostatic drugs, etc. Strictly limit activities for at least 2 weeks, keep the abdomen open, prevent respiratory tract infections, and avoid sudden increases in abdominal pressure that may lead to secondary bleeding.

3. Surgery

(l) Indications for surgery: ① Open renal trauma; ② Accompanied by intra-abdominal organ injury, or suspected massive intra-abdominal hemorrhage or diffuse peritonitis; ③ Blood pressure cannot be restored after anti-shock treatment or rises and then falls, indicating massive bleeding; ④ Objective examinations such as urography indicate obvious contrast agent spillage, large renal parenchymal rupture or renal pelvic injury; ⑤ Renal artery angiography shows renal artery injury or embolism; ⑥ During non-surgical treatment, the renal mass continues to increase, the macroscopic hematuria persists, and severe anemia occurs in a short period of time; ⑦ Obvious perinephric infection.

(2) The surgical approach is to first control the renal pedicle, stop bleeding, and remove the hematoma around the kidney and urine extravasation before exploring and treating the kidney. ① Renal laceration repair: The laceration is limited in scope and the entire kidney is well circumscribed. ② Partial nephrectomy

One end of the kidney is severely damaged, while the rest of the kidney tissue is intact or has lacerations that can be repaired; ③ Patients with renal pedicle vascular tears, ruptures, or thrombosis during renal vascular repair or renal vascular reconstruction; ④ Patients with severe kidney lacerations that cannot be repaired during nephrectomy, or severe renal pedicle vascular injuries that cannot be repaired or reconstructed; Patients with extensive thrombosis in renal blood vessels after renal injury; Patients with infection, necrosis, and secondary massive bleeding after renal trauma. Note that before removing the injured kidney, it must be confirmed that the contralateral kidney is functioning well.