Renal traumatic

Figure 1 shows the effect of traumatic or unpleasant interview on blood pressure, cardiac stroke volume, renal blood flow, and the fraction of the renal blood flow that was filtered at the glomeruli (filtration fraction). In response to the interview both the systolic and diastolic blood pressure and the stroke volume of the heart increased. There was a decrease in the flow of blood through the kidney, and this decrease was due predominantly to an efferent arteriolar constriction since the filtration fraction was increased somewhat. 

For the relief of pain arising from spasm of smooth muscle, as in renal or biliary colic, morphine is frequently employed. Other measures including antispasmodics such as atropine, atropine substitutes, theophylline, nitrites, and heat may be employed first however, if they are ineffective, meperidine, methadone, or opiates must be used. Morphine relieves pain only by a central action and may aggravate the condition producing the pain by exaggerating the smooth muscle spasm. Morphine may also be indispensable for the relief of pain due to acute vascular occlusion, whether this be peripheral, pulmonary, or coronary in origin. In painful acute pericarditis, pleurisy, and spontaneous pneumothorax, morphine is likewise indicated. Carefully chosen and properly spaced doses of codeine or morphine may occasionally be necessary in pneumonia to control pain, dyspnea, and restlessness. Traumatic pain arising from fractures, bums, etc., frequently requires morphine. In shock, whether due to trauma, poisons, or other causes, morphine may be required to relieve severe pain. 

Non-traumatic rhabdomyolysis is often secondary to alcohol, cocaine, amphetamines, heroin, etc, and is characterized by laboratory features that reflect the release of muscle cell contents into the plasma. Early detection can prevent progression to acute renal insufficiency (211). 

Sandhu JS, Sood A, MIdha V, Singh AD, Jain D, and Sandhu P. 2000. Non-traumatic rhabdomyolysis with acute renal failure. Ren Fail 22 81-86. 

Ron D,Taitelman U, Michaelson M, Bar-Joseph G, Bursztein S, and Better OS. 1984. Prevention of acute renal failure in traumatic rhabdomyolysis. Arch Intern Med 144 277-280. 

Chugh K5,5inghal PC, Nath IV5, Pareek 5K, Ubroi H5,5arkar AK. Acute renal failure due to non-traumatic rhabdomyolysis. Postgrad Med J 1979 55 386-392. 

Hypoglycemia can be seen. Rhabdomyolysis, acute renal failure, disseminated intravascular coagulation, liver necrosis, and traumatic injury are reported complications. The anesthetic dose of phencyclidine is 0.25 mg kg intravenously. Doses of 1-5 mg are purported to cause euphoria and numbness, 5-10 mg cause excitation and hallucinations, and 20 mg or more cause coma and serious toxicity or death. Plasma concentrations of phencyclidine vary widely after overdose. Phencyclidine crosses the placenta resulting in hyperirritability, tremors and hypertonia, depressed reflexes, and nystagmus in neonates. 

Patients at risk for SRMB include those with respiratory failure (need for mechanical ventilation for >48 hours), coagulopathy, hypotension, sepsis, hepatic failure, acute renal failure, multiple trauma, severe burns (>35% of body surface area), head injury, traumatic spinal cord injury, major surgery, or history of GI bleeding. " ""... 

FPL55712, in the endotoxaemic rat as measured by improvement in renal blood flow and absence of haemoconcentration. Additionally, pretreatment with LY171883 improved survival and indices of tissue injury in rats subjected to traumatic shock. ... 

As has been the case with the embolization of other solid organs as described in this chapter, it is recommended that these procedures start with a non-selective abdominal aortogram. Variations in the number of arteries supplying one or both kidneys are numerous and therefore must be documented before attempts at selective catheterization are made. In addition, the angle of origin between the abdominal aorta and renal arteries will help guide catheter selection for catheterization. Aortography is also important to rule out traumatic disruption or dissection of the renal artery before selective catheterization is attempted. Embolization is typically performed as distal as possible, or as close as possible to the site of arterial injury, in order to minimize the amount of devascularized renal parenchyma after the procedure. This typically requires the use of microcatheters and microcoils (Fig. 4.4). 

Embolization is also well suited to patients that are initially stable after trauma but develop delayed bleeding over the course of days, weeks, or months [86]. In these patients, the delayed bleeding is most likely due to the formation of a traumatic pseudoaneurysm or arteriovenous fistula, which is more common in patients experiencing penetrating trauma than blunt trauma [95]. Pseudoaneurysms form after blunt trauma due to rapid deceleration-induced injuries to renal arteries [96, 97]. As they form, pseudoaneurysms can contact the collecting system, which can lead to the delayed hematuria often seen in these patients [95]. These pseudoaneurysms can be successfully treated with selective embolization. 

Nash PA, Bruce JE,McAninchJW (1995) Nephrectomy for traumatic renal injuries. J Urol 153 609-611... 

Technical success of embolization for intrarenal vascular injury is quite high, around 95-100% [42-44]. Typically the recurrence rate is nearly 0% however, in one series a second embolization session was needed in 2 (15%) of 13 patients to fully occlude arteriovenous fistulas and achieve true technical success [44]. An analysis of the effect on renal function of selective embolization for traumatic renal lesions revealed that the mean volume of infarcted kidney was only 6% (range 0-15%) and 1 week postembolization the serum creatinine was normal in all their patients [42]. A series of renal transplants estimated that the maximal volume of infarcted kidney after embolization for biopsy-related injuries was always less than 30% [44]. Also, while renal function dete-... 

Tisnado J, Beachley MC, Amendola MA (1979) Transcatheter embolization of traumatic renal arteriovenous fistula. Urol Radiol 1 175-177... 

Typically pseudoaneurysm formation in the renal artery distribution is iatrogenic or traumatic. Other causes of aneurysm formation include fihromuscu-lar dysplasia, polyarteritis nodosa, amphetamine abuse, angiomyolipoma in the presence or absence of tuberous sclerosis, and neurofibromatosis. 

Secondary or acquired renal cyst (post-traumatic, chronic renal failure)... 

Acquired cysts can occur in post-traumatic and post-inflammatory (tuberculous, etc.) settings or spontaneously develop in kidney parenchyma during chronic renal failure and dialysis (Dunill et al. 1977 Leichter et al. 1988 Hogg 1992 see also Chap. 21). As in kidneys with acquired cysts such... 

Evaluating a child vdio has sustained abdominal injury is daily practice in a department of pediatric radiology. In this chapter, emphasis will be put on pediatric particularities of renal injuries. Obviously, renal trauma cannot be separated from associated traumatic lesions. This is especially true in organizing the imaging strategy. 

In the hours and days following the acute phase, intra- or extra-renal secondary bleeding is the main risk. It j ustifies hospitalizing traumatized children at the intensive care unit for a close clinical, biological and imaging follow-up. Ultrasound is the modality of choice for bedside follow-up when transportation to the radiology unit is considered difficult or even... 

Fig. 25.11 a-c. A 5-year-old boy who was the victim of a motor vehicle accident, a Enhanced CT scan (tubular phase) showing absence of opacification of the anterior part of the right kidney (note the cortex corticis enhancement pattern). b Same examination 2D reformatting in the coronal plane. No surgery was performed, c Four months later, follow-up CT (vascular and cortical phase) showed atrophy of the involved area. The inferred final diagnosis was traumatic lesion of the anterior branch of division of the right renal artery... 

Preparations of the herb are used in German phytotherapy for post-traumatic and static edema and in irrigation therapy for bacterial and inflammatory conditions of the lower urinary and renal tract (contraindicated in cases of impaired heart or kidney function). Externally, compresses or poultices are used for the supportive treatment of poorly healing wounds. 

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