Trauma renal

Pereira Júnior, Gerson Alves; Paganelli, Fernando; Scarpelini, Sandro; Stracieri, Luís Donizetti Silva; Féres, Ornar; Andrade, José Ivan de

doi:10.1590/S0100-69911999000100012

Resumos

Apresentamos uma revisão sobre trauma renal, com ênfase na avaliação radiológica, particularmente com o uso da tomografia computadorizada, que tem se tornado o exame de eleição, ao invés da urografia excretora e arteriografia. O sucesso no tratamento conservador dos pacientes com trauma renal depende de um acurado estadiamento da extensão da lesão, classificado de acordo com a Organ Injury Scaling do Colégio Americano de Cirurgiões. O tratamento conservador não-operatório é seguro e consiste de observação contínua, repouso no leito, hidratação endovenosa adequada e antibioti- coterapia profilática, evitando-se uma exploração cirúrgica desnecessária e possível perda renal. As indicações para exploração cirúrgica imediata são abdome agudo, rápida queda do hematócrito ou lesões associadas determinadas na avaliação radiológica. Quando indicada, a exploração renal após controle vascular prévio é segura, permitindo cuidadosa inspeção do rim e sua reconstrução com sucesso, reduzindo a probabilidade de nefrectomia.

Trauma renal; Tomografia computadorizada

We present a revision of the renal trauma with emphasis in the radiographic evaluation, particularly CT scan that it has largely replaced the excretory urogram and arteriogram in the diagnostic worh-up and management of the patient with renal trauma. The successful management of renal injuries depends upon the accurate assessment of their extent in agreement with Organ Injury Scaling classification. The conservative therapy managed by careful continuous observation, bed rest, appropriate fluid ressuscitation and prophylactic antibiotic coverage after radiographic staging for severely injured kidneys can yield favorable results and save patients from unnecessary exploration and possible renal loss. The indications for immediate exploratory laparotomy were acute abdomen, rapidly dropping hematocrit or associated injuries as determinated from radiologic evaluation. When indicated, renal exploration after trauma is safe and in a high percentage of cases reconstruction will be successful. Isolation of the renal vasculature before exploration of the renal trauma is believed to reduce blood loss, allow for more careful and confident renal inspection and reconstruction, and reduce the probability of nephrectomy.

Renal trauma; Kidney; Trauma; Wounds and injuries; Tomograph

ARTIGO DE REVISÃO

Trauma renal

Renal trauma

Gerson Alves Pereira Júnior, ACBC-SP^I; Fernando Paganelli^II; Sandro Scarpelini, TCBC-SP^III; Luís Donizetti Silva Stracieri, TCBC-SP^III; Ornar Féres, TCBC-SP^III; José Ivan de Andrade, TCBC-SP^IV

^IMédico Assistente do Departamento de Cirurgia, Ortopedia e Traumatologia

^IIAluno da Graduação da FMRP-USP

^IIIMédico Assistente do Departamento de Cirurgia, Ortopedia e Traumatologia. Mestre em Cirurgia pela FMRP-USP

^IVProfessor Doutor do Departamento de Cirurgia, Ortopedia e Traumatologia. Diretor da Unidade de Emergência do Hospital das Clínicas da FMRP-USP

^{Endereço para correspondência} Endereço para correspondência: Dr. Gerson Alves Pereira Júnior Hospital das Clínicas FMRP-USP Unidade de Emergência Rua Bernardino de Campos, 1.000 14015-130 - Ribeirão Preto - SP

RESUMO

Apresentamos uma revisão sobre trauma renal, com ênfase na avaliação radiológica, particularmente com o uso da tomografia computadorizada, que tem se tornado o exame de eleição, ao invés da urografia excretora e arteriografia. O sucesso no tratamento conservador dos pacientes com trauma renal depende de um acurado estadiamento da extensão da lesão, classificado de acordo com a Organ Injury Scaling do Colégio Americano de Cirurgiões. O tratamento conservador não-operatório é seguro e consiste de observação contínua, repouso no leito, hidratação endovenosa adequada e antibioti- coterapia profilática, evitando-se uma exploração cirúrgica desnecessária e possível perda renal. As indicações para exploração cirúrgica imediata são abdome agudo, rápida queda do hematócrito ou lesões associadas determinadas na avaliação radiológica. Quando indicada, a exploração renal após controle vascular prévio é segura, permitindo cuidadosa inspeção do rim e sua reconstrução com sucesso, reduzindo a probabilidade de nefrectomia.

Uniterrnos: Trauma renal; Tomografia computadorizada.

ABSTRACT

We present a revision of the renal trauma with emphasis in the radiographic evaluation, particularly CT scan that it has largely replaced the excretory urogram and arteriogram in the diagnostic worh-up and management of the patient with renal trauma. The successful management of renal injuries depends upon the accurate assessment of their extent in agreement with Organ Injury Scaling classification. The conservative therapy managed by careful continuous observation, bed rest, appropriate fluid ressuscitation and prophylactic antibiotic coverage after radiographic staging for severely injured kidneys can yield favorable results and save patients from unnecessary exploration and possible renal loss. The indications for immediate exploratory laparotomy were acute abdomen, rapidly dropping hematocrit or associated injuries as determinated from radiologic evaluation. When indicated, renal exploration after trauma is safe and in a high percentage of cases reconstruction will be successful. Isolation of the renal vasculature before exploration of the renal trauma is believed to reduce blood loss, allow for more careful and confident renal inspection and reconstruction, and reduce the probability of nephrectomy.

Key words: Renal trauma; Kidney; Trauma; Wounds and injuries; Tomograph.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Recebido em 3/4/98

Aceito para publicação em 9/11/98

Trabalho realizado na Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo - FMRP-USP.

1. McAninch JW - Injuries to the genitourinary tract. In Tanagho/McAninch (eds): General Urology - 13th edition. Califórnia, USA. W.B. Saunders, 1992; Capo 18, pp 308 - 326.
2. Cheng DLW, Lazan D, Stone N - Conservative treatment of type 111 renal trauma. J Trauma 1994; 36:491-94.
3. McAninch JW, Carro 1 PR, Armenakas NA, Lee P - Renal gunshot wounds: methodos of salvage and reconstruction. J Trauma 1993; 35:279-84.
4. McAninch JW, Carroll P, Klosterrnan PW, et al - Renal reconstruction after injury. J Urology 1991;145:932-37.
5. Eastham JA, Wilson TO. Ahlering TE - Radiographic assessment of blunt renal trauma. J Trauma 1991;31:1.527-28.
6. McAninch JW, Carrol PR - Renal trauma: kidney preservation through improved vascular control - a refined approach. J Trauma 1982; 22:285-90.
7. Knudson MM, McAninch JW, Gomez R, et al - Hematuria as a predictor of abdominal injury after blunt trauma. Am J Surgery 1992; 164:482-86.
8. Sagalowsky AI, Peters PC - Genitourinary trauma. In Walsh/ Retik/ Stamey/ Vaughan (eds): Campbell's Urology - 6'h edition. USA. WB Saunders, 1992. Vol. 3, Cap. 69, pp 2.571-2.594.
9. Gill B, Palmer LS, Reda E, et al - Optimal renal preservation with timely percutaneous intervention: a changing concept in the management of blunt renal trauma in children in the 1990s. Brit J Urology 1994;74:370-74.
10. Stevenson J, Battistella FD - The "one shot" intravenous pyelogram: is it indicated in unstable trauma 'patients before celiotomy? J Trauma 1994;36:828-34.
11. Tang E, Berne TV - Intravenous pyelography in penetrating trauma. Am J Surg 1994;60:384-86.
12. Eastham JÁ, Wilson TG, Ahlering TE - Urological evaluation and management of renal proximity stab wounds. J Urology 1993;150: 1.77\-73.
13. McAndrew JD, Comere Jr JN - Radiographic of renal trauma: evaluation of 1.103 consecutive patients. Brit J Urology 1994;3:352-54.
14. Taylor GA, Eichelberger MR, Potter BM - Hematuria: a marker of abdominal injury in children after blunt trauma. Ann Surg 1988; 208:688-93.
15. Carroll P, McAninch JW, Klosterman P, Greenblatt M - Renovascular trauma: risk assessment, surgical management and outcome. J Trauma 1990;30:547-54.
16. Kristjansson A, Pedersen J - Management of blunt renal trauma. Brit J Urology 1993;72:692-96.
17. Cass AS, Luxenberg M, Gleich P, Smith C - Long-term results of conservative and surgical management of blunt renal lacerations. Brit J Urology 1987;59:17-20.
18. Tong Y -C, Chun J-S, Tsai H-M, Linn JSN - Use of hematoma size on computerized tomography and calculated average bleeding rate as indications for immediate surgical intervention in blunt renal trauma. J Urology 1992;147:984-86
19. Moore EE, Shackford SR, Pachter HL, et al - Organ injury scaling: spleen, liver and kidney. J Trauma 1989;29:1.664-1.666.
20. Husmann DA, Morris JS - Attempted nonoperative management of blunt renal lacerations extending through the corticomedullary junction: the short-term and long-term sequelae. J Urology 1990; 143:682-84.
21. Husmann DA, Gilling PJ, Perry MO, et al- Major renal lacerations with a desvitalized fragment following blunt abdominal trauma; a comparison between nonoperative (expectant) versus surgical management. J Urology 1993;150:1.774'-77.
22. Carroll PR, McAninch JW, Wong A, et al - Outcome after temporary vascular occlusion for the management of renal trauma. J Urology 1994;51:1.171-73.
23.Corriere JN, McAndrew JD, Benson GS - Intraoperative decision- making in renal trauma surgery. J Trauma 1991;31:1.390-92.
24. Steinberg DL, Jeffrey RB, Federle MP, McAninch JW - The computerized tomography appearance of renal pedicle injury. J Urology 1984;132:1.163-64.
25. Eastham JA, Wilson TG, Larsen DW, Ahlering TE - Angiographic embolization of renal stab wounds. J Urology 1992;148:268-70.
26. McGonigal MD, Lucas CE, Ledgerwood AM- The effects of treatment of renal trauma on renal function. J Trauma 1987;27:471-76.
27. Cass AS - Preliminary vascular control before renal exploration for trauma. Brit J Urology 1993;71:493-94.
28. Carroll PR, Klosterman P, McAninch JW - Early vascular control for renal trauma: a critical review. J Urology 1989;141:826-29.
29. Nash PA, Bruce JE, McAninch JW - Nephectomy for traumatic renal injuries. J Urology 1995;153:609-11.
30. Bertini JE, FIeahner SM,. Miller P, Bem-Menachem Y, Fischer RP - The natural history of traumatic branch renal artery injury. J Urology 1986;135:228-30.

Endereço para correspondência:

Dr. Gerson Alves Pereira Júnior

Hospital das Clínicas FMRP-USP Unidade de Emergência

Rua Bernardino de Campos, 1.000

14015-130 - Ribeirão Preto - SP

Datas de Publicação

Publicação nesta coleção
25 Fev 2010
Data do Fascículo
Fev 1999

Histórico

Aceito
09 Nov 1998
Recebido
03 Abr 1998

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. McAninch JW - Injuries to the genitourinary tract. In Tanagho/McAninch (eds): General Urology - 13th edition. Califórnia, USA. W.B. Saunders, 1992; Capo 18, pp 308 - 326.

[2] 2. Cheng DLW, Lazan D, Stone N - Conservative treatment of type 111 renal trauma. J Trauma 1994; 36:491-94.

[3] 3. McAninch JW, Carro 1 PR, Armenakas NA, Lee P - Renal gunshot wounds: methodos of salvage and reconstruction. J Trauma 1993; 35:279-84.

[4] 4. McAninch JW, Carroll P, Klosterrnan PW, et al - Renal reconstruction after injury. J Urology 1991;145:932-37.

[5] 5. Eastham JA, Wilson TO. Ahlering TE - Radiographic assessment of blunt renal trauma. J Trauma 1991;31:1.527-28.

[6] 6. McAninch JW, Carrol PR - Renal trauma: kidney preservation through improved vascular control - a refined approach. J Trauma 1982; 22:285-90.

[7] 7. Knudson MM, McAninch JW, Gomez R, et al - Hematuria as a predictor of abdominal injury after blunt trauma. Am J Surgery 1992; 164:482-86.

[8] 8. Sagalowsky AI, Peters PC - Genitourinary trauma. In Walsh/ Retik/ Stamey/ Vaughan (eds): Campbell's Urology - 6'h edition. USA. WB Saunders, 1992. Vol. 3, Cap. 69, pp 2.571-2.594.

[9] 9. Gill B, Palmer LS, Reda E, et al - Optimal renal preservation with timely percutaneous intervention: a changing concept in the management of blunt renal trauma in children in the 1990s. Brit J Urology 1994;74:370-74.

[10] 10. Stevenson J, Battistella FD - The "one shot" intravenous pyelogram: is it indicated in unstable trauma 'patients before celiotomy? J Trauma 1994;36:828-34.

[11] 11. Tang E, Berne TV - Intravenous pyelography in penetrating trauma. Am J Surg 1994;60:384-86.

[12] 12. Eastham JÁ, Wilson TG, Ahlering TE - Urological evaluation and management of renal proximity stab wounds. J Urology 1993;150: 1.77\-73.

[13] 13. McAndrew JD, Comere Jr JN - Radiographic of renal trauma: evaluation of 1.103 consecutive patients. Brit J Urology 1994;3:352-54.

[14] 14. Taylor GA, Eichelberger MR, Potter BM - Hematuria: a marker of abdominal injury in children after blunt trauma. Ann Surg 1988; 208:688-93.

[15] 15. Carroll P, McAninch JW, Klosterman P, Greenblatt M - Renovascular trauma: risk assessment, surgical management and outcome. J Trauma 1990;30:547-54.

[16] 16. Kristjansson A, Pedersen J - Management of blunt renal trauma. Brit J Urology 1993;72:692-96.

[17] 17. Cass AS, Luxenberg M, Gleich P, Smith C - Long-term results of conservative and surgical management of blunt renal lacerations. Brit J Urology 1987;59:17-20.

[18] 18. Tong Y -C, Chun J-S, Tsai H-M, Linn JSN - Use of hematoma size on computerized tomography and calculated average bleeding rate as indications for immediate surgical intervention in blunt renal trauma. J Urology 1992;147:984-86

[19] 19. Moore EE, Shackford SR, Pachter HL, et al - Organ injury scaling: spleen, liver and kidney. J Trauma 1989;29:1.664-1.666.

[20] 20. Husmann DA, Morris JS - Attempted nonoperative management of blunt renal lacerations extending through the corticomedullary junction: the short-term and long-term sequelae. J Urology 1990; 143:682-84.

[21] 21. Husmann DA, Gilling PJ, Perry MO, et al- Major renal lacerations with a desvitalized fragment following blunt abdominal trauma; a comparison between nonoperative (expectant) versus surgical management. J Urology 1993;150:1.774'-77.

[22] 22. Carroll PR, McAninch JW, Wong A, et al - Outcome after temporary vascular occlusion for the management of renal trauma. J Urology 1994;51:1.171-73.

[23] 23.Corriere JN, McAndrew JD, Benson GS - Intraoperative decision- making in renal trauma surgery. J Trauma 1991;31:1.390-92.

[24] 24. Steinberg DL, Jeffrey RB, Federle MP, McAninch JW - The computerized tomography appearance of renal pedicle injury. J Urology 1984;132:1.163-64.

[25] 25. Eastham JA, Wilson TG, Larsen DW, Ahlering TE - Angiographic embolization of renal stab wounds. J Urology 1992;148:268-70.

[26] 26. McGonigal MD, Lucas CE, Ledgerwood AM- The effects of treatment of renal trauma on renal function. J Trauma 1987;27:471-76.

[27] 27. Cass AS - Preliminary vascular control before renal exploration for trauma. Brit J Urology 1993;71:493-94.

[28] 28. Carroll PR, Klosterman P, McAninch JW - Early vascular control for renal trauma: a critical review. J Urology 1989;141:826-29.

[29] 29. Nash PA, Bruce JE, McAninch JW - Nephectomy for traumatic renal injuries. J Urology 1995;153:609-11.

[30] 30. Bertini JE, FIeahner SM,. Miller P, Bem-Menachem Y, Fischer RP - The natural history of traumatic branch renal artery injury. J Urology 1986;135:228-30.

Brasil

Brasil

Trauma renal

Renal trauma

Resumos

Endereço para correspondência:

Datas de Publicação

Histórico