Bilateral renal artery thrombosis following blunt trauma: report of two cases

Climbing harness fit in kidney transplant recipients

OBJECTIVE

The superficial location of renal transplants places them at risk for traumatic damage. Significant injuries have been reported from automobile seat belts, for example. This study was designed to assess the potential for direct transplant injury from the use of climbing harnesses.

METHODS

Ten patients with kidney transplants were fitted with a variety of climbing harnesses after the locations of their grafts were defined.

RESULTS

With the exception of two harnesses in a single patient, all devices came into contact with all transplants.

CONCLUSION

Sports requiring the use of climbing harnesses (eg, rock climbing, rappelling, and challenge course participation) may be unsafe for recipients of kidney transplants.

Traumatic renal artery thrombosis

Traumatic bilateral renal artery thrombosis is a rare injury that may be under-diagnosed. The clinical hallmarks include epigastric or flank pain and proteinuria, or hematuria following blunt trauma to the back or abdomen. Traditional practice suggests that revascularization should not be attempted more than 20 hours after injury. A patient is described in whom the retroperitoneum was explored 48 hours after injury and was found to have bilateral renal artery thrombosis. Although no repair was attempted, renal function spontaneously improved over several weeks. The clinical course of this patient suggests that revascularization should be considered even if the diagnosis is made more than 20 hours after injury.

Renal artery and vein injury following blunt trauma

Blunt injuries of the renal vascular pedicle occur infrequently. The experience with fourteen cases of blunt renal vascular trauma is presented. Most patients were injured in motor vehicle accidents. The diagnosis was made immediately after admission in 6 patients, delayed in 5, and at autopsy in 3. Most patients presented with gross or microscopic hematuria. The diagnosis of renal vascular injury was suggested by IVP in most instances. Surgical management was used in the 6 patients in whom the immediate diagnosis of renal pedicle injury was made; primary vascular repair was carried out in 4 patients and nephrectomy in two. Conservative management was used in 4 of the 5 patients with delayed diagnosis, and nephrectomy was required in the fifth. Three patients received no treatment as two were dead on arrival and one die during laparotomy. Seven patients died (50%). One of the 7 survivors has a functioning kidney following repair of a renal vein laceration. Three patients with devascularized kidneys have been followed long term and have not developed hypertension. An IVP should be mandatory following severe blunt trauma, especially when hematuria is present. Renal arteriography is indicated with distortion of calyces, extravasation or nonfunction seen on IVP and allows a definitive diagnosis of renal vessel injury to be made.