Portal de Periódicos da CAPES

Renal Trauma

1962; Radiological Society of North America; Volume: 79; Issue: 5 Linguagem: Inglês

10.1148/79.5.816

1527-1315

Samuel D. Hemley, Nathaniel Finby,

Acute Kidney Injury Research

The diagnosis and treatment of renal injuries constitute one of the most controversial subjects in urology (1). The retrograde cathcter technic for opacification of the renal vessels (2–4) now permits a careful appraisal of the role that the renal artery plays in the ultimate fate of the kidney’s anatomy and function. Indeed, it may present a clue to the understanding of the pathophysiology of the young adult hypertensive whose disease has its origin in a lesion of the renal vessel or vessels. The end-results of trauma to the renal bed, such as atrophy, hydronephrosis, intra- or extrarenal calcification, and complete occlusion of the renal artery, are well known. The possibility of narrowing of the renal arteries or diminution in their number, secondary to incomplete thrombosis or alteration of the vascular bed with resultant decreased function, is documented by the following cases. Case Reports Case I: S. M., a 12-year-old Puerto Rican boy, was admitted to St. Luke’s Hospital on Feb. 1, 1961, after a fall from his sled in which he struck his left flank against a tree. He had pain in the left side of the abdomen, associated with nausea and vomiting. Physical examination revealed rebound tenderness in the left upper quadrant without costovertebral angle tenderness. The pulse was 84, respirations 21, and blood pressure 120/70 mm. Hg. The initial urinalysis demonstrated 30 to 40 red blood cells per high-power field and occasional granular casts. Two days later the urine was normal. Hemoglobin was 12 gm.; the white blood cell count was 19,700, with 97 polymorphonuclear leukocytes, 1 lymphocyte, and 2 monocytes; hematocrit 30 per cent. Blood urea nitrogen was 15 mg. per cent, rose to 25 in five days, and eight days later was 17. The intravenous pyelogram obtained shortly after admission revealed loss of the psoas margin and kidney outline on the left, with no evidence of renal function on that side. The right kidney was normal. The splenic shadow was unremarkable. On the fifth hospital day, a repeat intravenous pyelogram again failed to reveal any evidence of function of the left kidney. A retrograde examination performed the next morning demonstrated a normal collecting system on the left, and a few drops of clear urine were noted coming from that kidnev (Fig. 1). It was elected to treat the patient conservatively and he was discharged on Feb. 22. On May 3, 1961, an intravenous pyelogram indicated the presence of an extremely small amount of contrast material within two of the central calyces of the left kidney (Fig. 2). The blood pressure reading was 120/70 mm. Hg. The patient was readmitted on May 19 for study of the renal arteries. Physical and laboratory data, including blood pressure readings and blood urea nitrogen and urine studies, were normal. A retrograde catheter study of the renal vessels is illustrated in Figures 3 and 4.