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Pediatric Surgery (Pg 68-81) - page 25 / 33

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A. Anatomy

Paired retroperitoneal, T12, L1-L3

Left kidney more cranial than right

11x6x3 cm 150g in males, 135g in females

Gerota’s fascia – renal fascia surrounding perineal fat

B. Physiology

Renal and acid base physiology is important

Hyponatremia as a complication of fluid absorption during TURP

RTA

Hypercholoremic metabolic acidosis after urinary diversion using intestine

C. Blood Supply

Kidneys get 20% of cardiac output

One renal artery that branches – danger of ischemia

HTN: long-term sequelae of renal ischemia

Aberrant lower pole arteries congenital uretopelvic junction obstruction

D. Trauma

Mostly blunt, often MVA hematuria

Asstd with rib fracture, verterbral body and transverse process fractures, flank contusions/abrasions

Must consider retroperitoneal hematoma secondary to kidney trauma in shock pts

E. Evaluating and Treating Trauma

No need to image those with microhematuria without history of major deceleration injury or hypotension

Kids with deceleration injury think avulsion of uretopelvic jxn (may have normal urinalysis)

Lacs:

o

Minor: extends no further than renal cortex, no urinary extravasation or large hematoma, capsule may remain intact (Grades I and II)

o

Major: transcapsular rupture through corticomedullary junction often with extravasation or large perirenal hematoma (Grades III, IV, and V)

o

For more info on grades of renal trauma see fig 9-12

Hemodynamically STABLE pts:

o

CT scan

o

Minor contusion is most common

o

Requires renal exploration ONLY if CT shows major renal injury

Hemodynamically UNSTABLE pts:

o

OR for lap

o

“one shot” IVP – give IV bolus contrast, take image 10 min later

o

renal exploration if expanding or pulsatile retroperitoneal hematoma or abnormality on IVP

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