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Renal Trauma / Urogenital Trauma

- See:
     - Bleeding from Pelvic Frx
     - Urogenital Trauma from Pelvic Frx
     - Diff Dx of Hematuria

- Discussion:
    - pts w/ high probability for genito-urinary trauma include those w/ gross hematuria (or microscopic) associated w/ shock;
          - most severe injuries tend to occur w/ gross hematuria;
          - w/ concomitant pelvic fracture, bladder rupture is a common occurance;
    - microscopic hematuria w/o shock following trauma may be observed w/ repeated urinanalysis;
          - more often, microscopic hematuria is a consequence of contussion, and will resolve spontaneously w/o treatment;
    - renal imaging is required in all pts w/ microscopic ( > 5 pRBC/HPF) or gross hematuria sustaining penetrating trauma or in pediatric pts;
    - most common contrast x-ray is urography, which is indicated in pts w/ pelvic frxs & if gross or microscopic hematuria is present;
    - if microscopic hematuria is minor (< 10 RBC/HPF), repeat urinalysis may be indicated befored determining need for contrast urography;
    - in the report by Morey AF, et al (2001), the authors sought to establish guidelines for diagnostic imaging for bladder rupture in the blunt trauma victim with multiple injuries;
          - the authors evaluated a chart review (1995-1999) of patients with blunt trauma and bladder rupture at their four institutions and performed focused literature review of retrospective series;
          - of the 53 patients identified, all had gross hematuria and 85% had pelvic fracture;
          - the classic combination of pelvic fracture and gross hematuria constitutes an absolute indication for immediate cystography in blunt trauma victims;
          - existing data do not support lower urinary tract imaging in all patients with either pelvic fracture or hematuria alone;
          - Bladder Rupture after Blunt Trauma: Guidelines for Diagnostic Imaging 
    - HTN is uncommon after renal injury, ocurring less than 5% of pts;
          - when HTN does develop, it is caused by patial ischemia to a renal segment, which activates the renin angiotensis system