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Traumatic Urological Emergencies
RENAL INJURIES (Table 5.1)
The kidneys are retroperitoneal structures surrounded by perirenal fat; posteriorly are situated the vertebral column, associated spinal muscles, and the lower ribs, and anteriorly the contents of the abdomen. As such they are relatively protected from traumatic injuries. Because of this relatively protected position, a considerable degree of force is usually required to injure a kidney. Not surprisingly, therefore, there may be associated injuries to, for example, the spleen, liver, mesentery of the bowel, or other organs. Furthermore, renal injuries may not initially be obvious, hidden as they are by other structures. Thus, to confirm (or exclude) a renal injury, one must have a high index of suspicion that such an injury could have occurred, and arrange appropriate imaging studies.
In children, there is proportionately less perirenal fat to cushion the kidneys against injury, and thus renal injuries occur with lesser degrees of trauma.
Mechanisms and Cause
The nature of the injury provides useful information about the likelihood that a renal injury has occurred. There are two broad categories of renal injury—those due to blunt trauma and those due to penetrating trauma.