Injuries to the kidney. Introduction. The most common injuries of the urinary system. Although well protected by lumbar muscles, ribs, vertebral bodies and viscera, the kidneys have a great mobility, consequently, parenchymal damage and vascular injuries can easily occur.
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American Association for the Surgery of Trauma Organ Injury Severity Scale for the Kidney[*]Classification of Renal Injuries
Computed tomographic scan of a right renal stab wound (grade IV), demonstrating extensive urinary extravasation and large retroperitoneal hematoma
Arteriography demonstrating complete occlusion of the left renal artery secondary to thrombus formation
Technique for partial nephrectomy:
A, total renal exposure;
B, sharp removal of nonviable tissue;
C, hemostasis obtained and collecting system closed;
D, defect covered
A, typical injury in midportion of kidney;
B, débridement, hemostasis, and collecting system closure;
C, approximation of parenchymal margins;
D, sutures tied over gelatin sponge bolster
Hb 15.3 Hematocrit 43% WBC 6,200cmm Urinary sediment: Many erythrocytes; WBC 4-5/ hpf, oxalate crystals.
What is the next most appropriate step in management for this patient?
A. Intravenous pyelography
B. Diagnostic peritoneal lavage
C. CT with contrast
D. Lumbar spine X-ray
E. Renal angiography