Kidneys are the third most common solid organ injury in blunt abdominal trauma. Even with significant renal injuries, patients can fully recover with conservative management alone. Kidney rupture is similar to splenic rupture in that it is usually caused by a direct blow to the abdomen, side, or mid-to-low back which causes damage or a tear to the organ. This is frequently seen with high-contact sports such as football, rugby, ice hockey, soccer, horseback riding, gymnastics, boxing, sledding, and skiing. Though it is very rarely possible to happen spontaneously.
The kidneys are well protected by the ribs, abdominal muscles, back muscles, and supporting fascia. However, the lower poles of the kidneys are inferior to the 12th ribs and are therefore more susceptible to trauma.
Acute kidney injury (also called acute renal failure) means that your kidneys have suddenly stopped working. Your kidneys remove waste products and help balance water and salt and other minerals (electrolytes) in your blood. When your kidneys stop working, waste products, fluids, and electrolytes build up in your body. This can cause problems that can be deadly.
What causes acute kidney injury?
- Low fluid intake
- Nephrotoxic drug ingestion
- Trauma or exertion
- Blood loss/transfusions
- Exposure to toxic substances
- Exposure to mercy vapors or heavy metals
What puts an individual at risk for kidney rupture?
- Children are more susceptible to internal injury due to anatomic factors. Their decreased perirenal fat (decreased fat located around the kidneys), larger proportional size, and lack of complete rib protection due to lower position of the kidneys in the abdomen all increase risk of renal injury for children.
- Chronic heart failure
- Multiple myeloma
- Chronic infection
- Myeloproliferative disorder
- Connective tissue disorders
- Autoimmune diseases
Look for these symptoms in athletes when a kidney rupture is suspected:
- Hematuria (blood in urine) is the most common presenting sign of renal injury
- Right or left abdominal pain, mild or severe depending on rupture
- Muscle guarding
- Low back pain
- Abdominal bruising, swelling, and pain
- Signs of internal bleeding: decreased alertness, dizziness, fatigue, blurred vision, low BP, nausea, vomiting
- Decreased urine output or inability to urinate
- In severe cases shock may result – Increased heart rate, pale, cool skin
What else could this be?
- Any internal abdominal organ or arterial rupture
- Splenic rupture
- Rib fracture
- Upset stomach
How do you treat an individual with a kidney rupture?
Conservative management is widely accepted for all but the most severe blunt renal injuries in a stable patient. Surgical intervention in blunt renal trauma is required in less than 10% of cases. In a 7-year retrospective review study regarding patients with blunt renal trauma, 18.3% were grade III-V injuries.
- Assess Vital Signs (Blood Pressure, Pulse, Respiratory Rate)
- Call 9-1-1 (activate EMS)
- When at the hospital procedures may include:
- Surgery to repair organ, or remove it completely (Nephrectomy).
- Aspiration to remove pooled blood and swelling
- CBC (complete blood count)
- CT scan (Computed Tomography)
- Diagnostic Ultrasound
- Current practice recommendations state that all children with blunt trauma and hematuria should be imaged regardless of blood pressure or degree of blood in the urine.
When can the individual return to activity?
Depending if the kidney was repaired, excised (removed), or left to conservative treatment, return to play may vary case-by-case, but full recovery may take up to three weeks, providing there are no complications. Athletes are not typically allowed to return to play to contact sports with one organ that is normally paired, however some physicians or circumstances may allow it.
Conservatively managed athletes with renal contusions should be observed until hematuria clears and should be excluded from contact sports for 6 weeks. However, RTP is individualistic and depends on severity/intensity of the injury and the individual athlete. More severe injuries may take 6-8 weeks to heal and return to contact/collision sports can be delayed 6 to 12 months with extensive renal injuries, where as some may not choose to return to his/her respective sport.
Whether moving to a non-contact sport or cleared by a physician for contact, an Athletic Trainer or sports medicine professional should coach the athlete back through gradual return to play and monitor for red flags or return of signs or symptoms.
- Harper K, Shah KH. Renal Trauma After Blunt Abdominal Injury. J Emerg Med. 2013; 45(3):400-404.
- Holmes FC, Hunt JJ, Sevier TL. Renal Injury in Sport. Curr Sports Med Rep. 2003; 2:103-109.