Function of the Kidneys
Each person has two kidneys, which are located on either side of the spine, behind the intestines and just above the waist.
The kidney cleans the blood by filtering out waste materials and getting rid of any water the body doesn't need. The liquid waste made by the kidneys is called urine. The kidneys are part of the renal or urinary system. The renal system also includes the ureters, bladder and urethra.
Urine is made in the kidneys and it passes through the ureters. The ureters are small tubes that connect the kidneys to the bladder. The bladder stores the urine. The urine then goes from the bladder through a tube called the urethra to the outside of the body.
Diagnosis of Kidney Injuries
Children with a kidney injury may have bruising, pain in their back, blood in their urine, or abdominal pain after the trauma or injury.
If a kidney injury is suspected, the trauma surgery providers will thoroughly and carefully examine your child. A urinalysis (urine test) will test if there is blood in the urine. X-rays, a computed tomography (CT) scan, ultrasound or blood tests may be done to determine how badly your child's kidney is damaged.
The American Association for the Surgery of Trauma (AAST) grades kidney injuries 1-5. The grade is determined by the size and location of the injury in the kidney seen on CT scan. Grade 1 is the least severe and 5 is the most severe.
Treatment for Kidney Injuries
Typically, children with grade 1 - 4 kidney injuries are admitted to the general care unit. Children with grade 5 kidney injuries may be admitted to the general care unit or to the intensive care unit (ICU). Fortunately, most kidney injuries are treated without surgery. Depending on the grade of injury, treatment can include strict bed rest, nothing to eat or drink for a short period of time, pain control, lab work, and IV fluid hydration. Blood transfusions can sometimes also be necessary. A urologist (urinary system doctor) may also be consulted to help care for your child.
For a large kidney injury, sometimes surgery is needed to stop urine from leaking or to stop the bleeding.
If your child has surgery, he / she will not be allowed to eat after surgery for some time. However, he / she will be given an IV (a small tube in their vein) for fluid hydration. He / she may also have a nasogastric tube (a tube placed through the nose into the stomach) after surgery to keep their stomach empty. Your child will be closely watched in the ICU after surgery for a few days to watch for any bleeding, then moved to the general care unit as healing continues.
Medications and Pain Management
Speak to your trauma surgery provider about medications your child was taking prior to their admission to the hospital and obtain approval to resume home medications. Your child may have some pain or soreness at home.
Give Acetaminophen (also known as “Tylenol") for pain. Your child's trauma surgery provider may also write a prescription for stronger pain medication. Give the stronger medication if the pain does not go away one hour after giving Acetaminophen. Follow the directions on the prescription.
Do not give your child NSAIDs or Ibuprofen (also known as Motrin", Advil", Aleve", etc.) until the trauma surgery provider says that it is okay. Your child may require a stool softener while taking prescription pain medication to prevent constipation and straining with bowel movements. .
Wound and Skin Care
Your child may shower or take a bath, but he / she may need help for several days after going home.
If you child has had surgery, check with your trauma surgery provider about taking a shower or bath. Follow instructions given by your trauma surgery provider regarding any other injuries or wounds.
Activity After a Kidney Injury
Your child does not need to stay in bed but should walk and play quietly. They may return to school in one to two weeks but your child will be on strict activity restrictions for some time. Strict activity restrictions include no gym, running, competitive / contact sports, activities with wheels, or any activity in which both feet leave the ground at the same time. After the initial strict activity time period, he / she should not participate in any competitive / contact sports until instructed by the trauma surgery provider. The length of activity restrictions will depend on the grade of the kidney injury.
Returning to Daycare or School
Your child may require some time off school to be at home to rest. Your trauma surgery provider will give you recommendations regarding going back to school. If surgery was needed or your child has other injuries, they may be out of school longer. At school, your child should not be taking gym class until your trauma surgery provider says it's okay. Your child should leave class five minutes before the other students, to avoid bumping into other children in the halls. Your child should not carry or lift more than one to two textbooks at a time, even if he / she carries a book bag or backpack.
When to call your Trauma Surgery provider
Call the trauma clinic or seek medical attention if your child has:
- Increased or worsening abdominal pain
- Fever >100.5
- Difficulty with bowel movements
- Shortness of breath
- Nausea / vomiting
- A fast heart rate
- Concern for wound infection (redness, swelling, pus drainage, or increased wound pain).
After the injury, your child may be tired and irritable. It takes time to heal. Use this time for rest and quiet activities. Have your child play board games, read, or do small craft projects for short periods of time.
Infants and toddlers are harder to distract and will be more difficult to confine. Try putting your infant or toddler in a large crib or playpen. Ask family and friends to visit, but for short periods of time and not at the same time to minimize activity.
After any trauma children may experience acute stress symptoms that may be reflective of post-traumatic stress disorder (PTSD). If you notice your child having nightmares, flashbacks, nervousness, irritability or any other concerning emotional symptoms please speak with the trauma surgery provider. Short term therapy can be provided to help children heal and recover emotionally after a trauma.
Follow-up / Contact Us
All children with a kidney injury will be seen in the Trauma Clinic one or two weeks after discharge. An appointment will be made for you before you leave the hospital or you will be given a number to call to make an appointment. The trauma clinic number is 513-636-8556.
Usually, no follow-up testing is needed. Sometimes, for a larger kidney injury, the Division of Urology will order a follow-up ultrasound to look for healing. Once it is okay for your child to return to normal activity, no further follow-up will be needed. After your child has healed, he / she is not at an increased risk to hurt their kidney again.
It is very important to teach your child about all types of safety. Make sure your child is secured in an age-appropriate restraint every time they ride in a vehicle. Children under 13 are safer in a backseat in the correct restraint.
Make sure your child wears the correct helmet when riding a bike, using other wheeled toys, or takes part in other active sports.