We can all agree that any game that is intensive and full of adrenaline coupled with a lot of contact will lead to numerous injuries. American football as some call it is one of the most intensive and contact oriented sports activity. Recently, the number of players suffering from kidney lacerations has increased at a fast rate; causing researchers to research on the relationship between the two.
Football is a dangerous game. We all have heard about the head injuries players receive that can cause long-lasting damage. We also have seen players sidelined by serious orthopedic injuries. Now a different type of injury is taking players out of the game – kidney laceration. “A kidney laceration is usually caused by blunt force trauma,” says Jeffrey Campsen, M.D., a kidney surgeon with University of Utah Health Care. “It’s an injury that is commonly associated with car accidents.” Kidney lacerations cause pain, usually in the upper abdomen or in the hip flank. Both Allen and Luck sought medical care after feeling pain in their sides following their injuries. “In more severe cases, the patient may go into shock as well,” says Campsen. And, “blood in the urine is also a common symptom.” That was what led to a kidney laceration diagnosis for Miles Austin of the Cleveland Browns. The receiver thought he just had a post-game stomachache before he hit the urinal.
Kidney lacerations are painful injuries found in the upper abdomen and hip flank. The symptoms can vary and mild damage may initially show no symptoms. However, severe cases can lead to shock and death is a real eventuality.
- Usually the abdomen will be painful on palpation.
- Blood in the urine (hematuria).
- Nausea or vomiting.
- Changes in blood pressure and pulse.
- Shock which may lead to unconsciousness.
- 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.
Some of the more common symptoms include; abdominal pain, low back pain, vomiting, and nausea. However, there are some predisposing factors that increase the probability of an individual suffering from lacerations.
- 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
- Low fluid intake
- Nephrotoxic drug ingestion
- Trauma or exertion
- Blood loss/transfusions
- Exposure to toxic substances
- Exposure to mercy vapors or heavy metals
Trauma or exertion is one of the main causes of lacerations. Football players have an increasing chance of experiencing exertion and trauma more than once in their career, which makes sense with the increasing numbers of lacerations. The following are some treatment options available to patients;
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)
- 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 at the hospital procedures may include:
- An Aortogram. This is where a special dye is injected into the main artiery (the aorta). X-rays are then taken of the area as the blood containing the dye travels through the kidneys. A leak can be seen clearly here.