Renal Traumas in Nephrologic Patients

Injury to the genitourinary tract, although only occurring in approximately 10% of trauma cases, is an important topic. Most kidney damage results from closed trauma, generally due to car accidents, falls, or assaults. Recent improvements in imaging techniques, as well as the development of a validated renal injury scoring system, have shifted the therapeutic algorithm towards a more conservative approach than surgery. The medical history collection and a thorough physical examination of the chest, back, and abdomen including airway, breathing, and circulation assessment and vital sign monitoring are the cornerstones of the initial approach to renal trauma management. The more recent guidelines indicate computer tomography (CT) with contrast enhancement in stable patients presenting with gross or microscopic hematuria with a systolic blood pressure below 90 mmHg. CT allows for recognition of arterial extravasation and/or renal collecting system injuries, as well as assessment of preexisting renal pathology and evaluation of any damage to the contralateral kidney or other organs. Ultrasound (US) evaluation represents a valid alternative to CT thanks to its safety and reproducibility even in hemodynamically unstable patients. The use of contrast-enhanced ultrasound (CEUS) significantly improves the diagnostic performance of ultrasound with a good correlation with CT findings, thus proposing itself for the next future as the first-choice imaging technique in the follow-up of nonsurgical renal traumas.