Kidney bruise - causes, symptoms and therapy

Bruised kidney treatments and signs

Compared to many other kidney diseases, which can sometimes be life-threatening, renal contusion (kidney contusion) in the vast majority of cases means only mild lesions that can be repaired without complications through appropriate treatment. However, there are also exceptions where the bruise causes more severe damage to the kidney. For this reason, kidney bruising should always be seen by a doctor, regardless of their suspected severity. More details about the character, possible causes and treatment steps are given in our article on this topic.

contents

• Bruised kidney treatments and signs
• definition
• Accidents as the main cause
• Iatrogenic causes
• symptoms
• diagnosis
• therapy

definition

The paired kidneys (Ren or Nephros) are essential for our metabolism. Not only do they regulate the water balance of the body by forming the urine necessary for natural drainage, they also release harmful toxins from the organism. In addition, residues of recyclable substances are absorbed in the kidneys, which ensures the best possible nutrient utilization for the metabolism. And even in the formation of blood and blood pressure, the kidneys are involved, because on the one hand, the excretion of fluid regulates the blood volume and thus controls the pressure within the blood vessels. On the other hand, the kidneys also form hormones such as erythropoietin, which is responsible for the formation of red blood cells.

A kidney bruise can usually be remedied without complications by suitable treatment measures, but should always be examined by a doctor. (Image: Romario Ien / fotolia.com)

In order for the kidney to be able to fulfill its various tasks, it has an extremely complex structure characterized by various functional tissue structures, the so-called parenchyma. In the kidney area, this functional subunit of the organ is also called nephron and consists essentially of the following two elements:

• Kidney corpuscles (corpuscular renal):
  The renal corpuscles extract the primary urine from the blood via the kidney's own vascular system. It consists mainly of protein-containing blood plasma, which is still unfiltered on entry into the renal corpuscles.
• Renal tubules (tubulus):
  Upon arrival in the renal corpuscles, the primary urine is channeled into the renal tubules, which filter important nutrients from the blood plasma and return them to the bloodstream. Also, a large amount of water is removed from the primary urine here, whereby the urine is concentrated and becomes the actual final urine.

What remains here is an aqueous mixture of substances which, in addition to a water content of 95 percent, consists essentially of the following substances:

• Uric acid - end product of purine metabolism,
• Urea - end product of protein metabolism,
• Creatinine - end product of muscle metabolism and digestion of meat,
• Salts and phosphates - mostly end products of the acid metabolism,
• Urochrome - end products in the breakdown of protein and the red blood pigment bilirubin; Urochromes are natural, nitrogen-containing dyes that give the urine its typical yellow color.

The kidneys are well concealed on the back wall of the abdomen, where they are well protected by abdominal organs, spine and back muscles. (Image: Peter Hermes Furian / fotolia.com)

Localized are the kidneys well hidden on the back wall of the abdomen. From the front they are equally protected by the numerous abdominal organs and from behind by the spine, ribs and the strong muscle trains of the back muscles and fixed in their position. Thanks to this good padding, the kidneys are rarely affected by injuries, unless they are affected by an external trauma. And this is where kidney bruise originates. It describes a lesion that results in a mostly accident-related, short-term bruising of kidney parts and is accompanied by a bruise. Medically, kidney bruising is counted as a so-called renal trauma, which describes the totality of all kidney injuries or kidney lesions.

All in all, kidney bruising accounts for only about two percent of all injuries in everyday life. However, if the abdominal and pelvic area are affected by external trauma (for example due to a traffic accident), the probability of kidney involvement increases to about 35 percent. Kidney bruising may be more or less dangerous depending on the severity of the kidney area bruising. Here is a brief overview of the different severity levels:

• Kidney contusion grade I:
  A good two-thirds of all kidney bruises are a first degree bruise that causes a slight bruise but no more severe injuries. Kidney bruises of this kind are therefore rather harmless, because the bruise is limited only to the connective tissue capsule surrounding the kidney. The parenchyma, ie renal corpuscles and renal tubules, are displaced but not damaged in the first degree of kidney rupture and the bruise does not expand in the further course.
• Kidney contusion grade II:
  Kidney bruising of the second degree is already associated with additional injury to the parenchyma, although it is still relatively small at the second severity. In detail, it is a parenchymal tear of less than an inch. The bruise is thus usually harmless and can be easily remedied by appropriate treatment. The hematoma may eventually expand beyond the connective tissue capsule in grade II renal failure.
• Kidney contusion grade III:
  In a kidney bruise of the third degree, the parenchymal tear is already much larger with over one centimeter. In addition, bruises of this severity almost always have a deeper hematoma. However, conservative treatments are usually sufficient in this case as well.
• Kidney contusion grade IV:
  Kidney bruises become really worrying if they go beyond the first three degrees of severity. A fourth degree bruise already means severe injuries to the functional structures of the kidney, which can lead to disturbances in urination. Operative measures to supply the bruise can hardly be avoided in such a scenario.
• Kidney contusion grade V:
  Kidney bruising of the fifth degree occurs after an unlikely major external trauma and, in addition to kidney injuries, also causes injuries to the urinary tract. It can even lead to a complete rupture of the urinary tract from the kidney, resulting in a life-threatening condition. Only emergency surgery can prevent a fatal kidney failure here. Fortunately, such severe bruises are rare.

Accidents are one of the main causes of kidney failure, such as sports accidents. (Image: bokan / fotolia.com)

Accidents as the main cause

In most cases, kidney bruises are triggered by blunt trauma. This is defined as a large and broad force applied to a body region at more or less high speed. Typical scenarios in which such violence affects the kidney are:

• Traffic accidents (eg rear-end collision),
• Sports accidents (for example in contact or martial arts),
• Everyday accidents (for example falls from high altitude),
• Occupational accidents (eg by collision with heavy loads),
• physical altercations (for example, beating or kicking the kidney).

In connection with car accidents kidney bruising even occur relatively frequently, as it comes to the impact of a very strong rebound of the accident participants in the car seats. In addition, massive effects of violence on the abdomen (so-called blunt abdominal trauma) can have an unfavorable effect on the kidney area due to the exerted force. Assaults, especially punches or kicks on the flank area, are the second leading cause of kidney bruise after car accidents.

Iatrogenic causes

In a few cases, renal contusions may also be iatrogenic. An iatrogenic cause is referred to in this regard, if the injury is caused by a medical or nursing measure. It primarily does not matter if the injury was theoretically avoidable or unavoidable. Only the fact that it was induced by medical personnel is of importance here. An example of iatrogenic kidney contusion is given in the treatment of kidney stones by shock wave treatment. Here, the externally induced shock waves at the level of the kidneys can lead to a mostly slight pronounced Nierenprellung. However, this should regress within a few days after completion of the shockwave therapy.

symptoms

As a cardinal symptom, the bruising (hematoma) typical for bruising and severe flank pain in the affected kidney area are the main sign of kidney contusion. In addition, the bruise can be accompanied by typical injury symptoms, some of which are also visible or palpable from the outside. Which includes:

• Bleeding to the outside (with accompanying laceration),
• Pressure pain in the area of ​​the bruise,
• Warming of the bruise,
• Blue discoloration under the skin,
• redness,
• swelling.

The main symptoms of kidney bruising are usually the typical bruising and severe flank pain. (Image: Syda Productions / fotolia.com)

The flank pain is described by those affected mostly as dull and boring, but can also be of outstanding quality. Localized the pain is usually one-sided, based on the bruised flank area, possibly with radiation into other parts of the back and abdomen. It often happens, therefore, that patients with alleged abdominal or back pain in the doctor or a doctor to represent and only on closer inspection of the circumstances surrounding the suspected diagnosis kidney bruising is envisaged.

The flank pain does not necessarily have to occur directly after the event, but can also show itself only in the course or delayed. Since the kidneys are well protected in the posterior abdomen and also have a connective tissue capsule and a fat pad, it may take a while for any tears within the kidney capsule due to the burst blood vessels to cause pain.

For this reason, attention should also be given to delayed flank pain, which is delayed in time for the accident. A typical scenario here is a slight rear-end collision, which initially seemed to have no consequences for those involved in the accident and in which only after one to two days a severe flank pain sets in as an indication of a kidney trauma.

Another symptom that can be added at higher severities of kidney bruise is blood in the urine (hematuria). This symptom is highly probable, especially in the case of kidney bruising of the fourth and fifth degree, and is due to the kidneys' task of filtering the blood flowing through and excreting the urine-containing substances via the urine. Kidney bruise, which involves deeper injuries to the kidneys, therefore results in varying degrees in smaller or larger bleeding into the renal corpuscles or renal tubules. In addition, if the ureters are involved in the injury, the escaping blood can enter directly into the draining urethra and thus discolour the urine even after the actual filtering.

Due to the filter function in the renal tubules, the hemorrhages in the primary urine are often not visually detectable as the red blood cells are usually transferred back into the bloodstream. Even small bleedings are sometimes not so well visible in the urine.

In such cases, one also speaks of a microhematuria, which can usually be detected only by means of laboratory tests due to the small amounts of blood. On the other hand, it looks different with bleeding into the draining urinary tract. Here, there is no further filtering of the urine, which is why the blood contained in the urine or the associated red color of the urine is usually recognizable to the naked eye. Medically, this form of hematuria is also called gross hematuria.

The amount of the detected blood in the urine does not always provide information about the extent of the damage, but serves the attending physician as a course criterion of the healing process.

Attention: If severe internal bleeding is present or the victim is shocked, a severe kidney bruise as a result of an accident quickly becomes a life-threatening situation. This is also the assumption that other organs were damaged by the accident and rapid intervention by medical personnel is absolutely necessary. A kidney trauma in conjunction with a shock then also shows the following symptoms:

• Awareness disorders (restlessness, confusion, drowsiness),
• pale skin,
• Drop in blood pressure (hypotension),
• cold sweat,
• fast, flat pulse (tachycardia).

diagnosis

To determine a bruise in the kidney area the doctor is often enough to have a gaze diagnosis. Swelling and bruising speak a clear language here. In addition, based on the patient survey, the underlying course of the accident can be easily reconstructed and used by a physical examination of pressure pain as a guide to the extent of the bruise. However, to be able to actually assess the severity of kidney bruising, additional information is needed.

If, for example, the patient complains of urinary pain and blood in the urine, there is a suspicion that serious internal injuries have occurred. More details promotes a urine sample here. In addition, doctors or the doctor will be advised to use severe kidney bruising, imaging techniques such as ultrasound, CT or MRI to assess the location and extent of kidney injury.

therapy

With the exception of really severe cases, which fortunately are rare in kidney bruising, most bruises in the kidney area are conservatively treated. In addition, some private measures, herbs and home remedies can help accelerate the healing process.

A major component of the treatment of kidney bruising is a lot of rest, lying and greatly reducing physical effort. (Image: Leonid / fotolia.com)

Conservative treatment

The conservative treatment of mild kidney bruising includes, above all, protection and cooling. Those affected should definitely reduce their daily workload and provide sufficient rest. In particular, movements that strain the flank and hip region heavily, such as stooping, heavy lifting or intensive running sessions are to be omitted. Concerned patients must lie as much as possible, so that the body can concentrate on the healing of the kidney bruise. However, in view of additionally threatening back problems caused by the long lying, occasionally also a slight movement should be incorporated, for example in the form of a slow walk into everyday life.

If possible, a minimum of one-week incapacity to work should also be considered, which the attending physician will issue in any case during work-intensive and height-intensive occupations.

As far as sufferers tolerate it, cooling elements such as cool packs or cool envelopes can be placed on the flank. Cooling reduces the bleeding into the tissue and the resulting swelling through contraction of the blood vessels. However, cooling only makes sense as long as it is good for the patient. In addition, cooling measures for the conservative supply of the bruise are to be applied for a maximum of ten minutes at a time, otherwise local frostbite, impaired sensation and, in this special case, also urinary tract infections and pyelonephritis may occur.

home remedies

The patient himself can largely help shape the healing of the kidney bruise already in conservative care by continuing to take care and cooling measures at home. Spreading of the bruising hematoma can be further reduced with envelopes previously soaked in vinegar. Even quark envelopes are used successfully as a home remedy for the treatment of large-area hematomas.

On the other hand, it is important to avoid the intense influence of local heat on the bruise during the initial healing phase. The heat can actually potentiate the already severe pain. The application of hot water bottles, hot showers or even a full bath are therefore not advisable during the healing of kidney bruising.

Of course, nothing speaks against a shower for the traditional body care, it improves the situation of the patient already alone with regard to a good well-being. However, the temperature of the morning shower should not be too high and the duration of showering should be kept to a minimum. However, those affected still know best what is good for them.

Since kidney trauma can always lead to further kidney disease, the kidney function should also be maintained and stimulated by appropriate private measures. Here, the intake of much fluid is the drug of choice. If you like the taste, you can also use special bladder and kidney tea, because the herbs contained in it promote kidney and bladder activity.

Bearberry tea has always been used to treat kidney problems, helps heal kidney bruising and reduces pain. (Image: Heike Rau / fotolia.com)

Naturopathy

Teas are always a good choice for urinary and kidney problems, as they flush through the urinary tract on the one hand, and on the other hand, they can be used to directly direct beneficial substances into place on the spot. There are numerous kidney herbs, which can contribute to the rapid recovery. The bearberry in particular has always been used for complaints in the kidney area and can both support wound healing and reduce existing pain. Also in support of the healing of a kidney bruise, especially in traumatic causes associated with severe pain and hematoma promise two homeopathic preparations relief:

• Arnica:
  Externally applied as an envelope soaked in Arnica tincture or applied internally in the form of taking several times a day three to five arnica globules.
• Traumeel:
  Combination preparation of 14 homeopathic substances, including Arnica montana, Achillea millefolium, Symphytum officinale and Aconitum napellus, which supports the healing of blunt injuries. Can be used externally and internally depending on the application form.

The list of tea herbs, which strengthen the kidney in particular, can be continued even further. For example, this happens again and again

• Aronia,
• Thlaspi arvense,
• hibiscus,
• bilberry,
• ginger,
• lovage
and water

recommended. The medicinal plants have similar to Bearberry, Arnica and Traumeel disinfecting properties, which also protects against injury-related inflammation. In addition, it is also possible with the use of envelopes to soothe the bruise herbs into the treatment. The following herbs are particularly suitable for this:

• Angelika,
• comfrey,
• Spruce,
• St. John's Wort,
• Fighter,
• rosemary,
• sweet clover,
• juniper.

Medical therapy

If the damage, or the pain that causes kidney bruise, is more pronounced, medical and surgical methods are also used. The indication for this is the treating physician depending on the degree of damage and the expected complications.

In the acute phase of kidney contusion, which is often associated with severe pain, analgesics are often used. (Image: areeya_ann / fotolia.com)

When it comes to medicines, painkillers such as ibuprofen, diclofenac and novalgin can be used in the acute phase of kidney contusion, which, as mentioned, is usually accompanied by severe flank pain. If the person is also plagued with spasmodic conditions in the abdominal area, Buscopan is a tried and tested remedy.

The external hematomas can be stopped well with a blood-thinning and coagulation-promoting ointment. Well-known preparations include Voltaren, Mobilat, Dolobene and Hepathromb. The ointments support the removal of metabolic waste products and clotted blood in the area of ​​the bruise and thus contribute to a faster reduction of hematoma or swelling.

As a complication of kidney bruising there is always a threat of nephritis or even sepsis in the room. Therefore, depending on the extent of renal trauma adapted antibiotic therapies are included in the treatment regimen.

Operative therapy

In case of mild kidney bruising, surgical therapy is completely eliminated in favor of a conservative healing approach. However, kidney traumas of greater extent may lead to such a tension in the area of ​​the connective tissue capsule that it must open in the sense of organ preservation under operative conditions and the escaping blood must be drained via drainage systems.

If the pathways are at risk due to the consequences of the damage and, for example, a rupture of the renal pelvis threatens, it may well be necessary for them to be secured by the surgical insertion of splints.

Also indicated is a surgical procedure when it comes to co-injury of the draining urinary tract or another abdominal organ. Depending on the type of injury may need to be sewn here. Whether such an operation is necessary, treating physicians decide from case to case. (Ma)