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Introduction:
Renal trauma accounts for 5% of all trauma cases. Rare mechanisms of injuries including sports participation are increasingly common. Rugby-related trauma poses a conundrum for physicians and players due to the absence of clear guidelines and a paucity of evidence. Our series highlights traumatic rugby-related renal injuries in our i...
Contexts in source publication
Context 1
... However, in recent years a conservative approach has been advocated [4]. The role and timing of follow-up imaging also remains a conten- tious issue [5]. Evidence supports no interval imaging for Grade I and II renal trauma [6,7]. The European Associ- ation of Urology (EAU) has published a management al- gorithm for traumatic renal injuries [7] ( fig. 1), however only half of urologists in Great Britain utilize them ...
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Objective:
Current urologic renal trauma guidelines favor conservative management. In 2012, we implemented an institution-wide renal trauma protocol to standardize management. This protocol details initiation of DVT (deep vein thrombosis) prophylaxis, cessation of bed rest, and frequency of laboratory studies. We hypothesized that low-grade injuri...
Citations
... There is an increasing incidence (16-30%) of renal trauma secondary to contact sports. 2 We report a case of a traumatic kidney injury in a 16-year-old girl after being tackled during a game of rugby. ...
Rugby-related renal trauma is rare and identification of a young patient with renal trauma secondary to sports who requires observation versus further radiological evaluation in the emergency department (ED) poses a diagnostic challenge. We report a case of a 16-year-old girl who presented to the ED with abdominal pain after being tackled during a game of rugby. Examination revealed tenderness over the right lateral lower ribs and right flank. Blood tests were normal and bedside ultrasound did not show any free intraperitoneal fluid. Urinalysis showed gross hematuria. She was pain-free after analgesia but had a syncopal episode in the ED. A computed tomography (CT) scan of the abdomen and pelvis showed a complex right lower pole renal laceration and she was admitted to the Intensive Care Unit. She remained stable and was discharged. Assessment with urinalysis, hematocrit, and creatinine is required during the evaluation of a patient with suspected renal trauma. CT scan is the imaging modality for the diagnosis and grading of renal injury. Conservative treatment is the mainstay of therapy, but some patients require angioembolization of surgical intervention. Patients must discuss with their physician regarding the optimal timing of return to rugby. Rugby-related renal trauma is rare and poses a challenge for emergency physicians regarding their evaluation and management in the ED. AAST-OIS grading of renal trauma on CT imaging helps guide appropriate management decisions.
... The evidence of AKI cases in both contact and non-contact sports has been increased, but with clear different etiological backgrounds [3][4][5]. In contact sports like football, boxing, and rugby, AKI cases have been related to kidney contusion or trauma (grade I in American Association for Surgery of Trauma classification) during tackles, punches, or other high-intensity actions with direct impact to the body [6,7]. On the other hand, in non-contact sports (e.g., endurance running and cycling), AKI has been related to the high number of muscle eccentric-concentric contractions leading to muscle damage [8,9]. ...
1) Background: This study aimed to explore wearable sensors′ potential use to assess cumulative mechanical kidney trauma during endurance off-road running. (2) Methods: 18 participants (38.78 ± 10.38 years, 73.24 ± 12.6 kg, 172.17 ± 9.48 cm) ran 36 k off-road race wearing a Magnetic, Angular Rate and Gravity (MARG) sensor attached to their lower back. Impacts in g forces were recorded throughout the race using the MARG sensor. Two blood samples were collected immediately pre-and post-race: serum creatinine (sCr) and albumin (sALB). (3) Results: Sixteen impact variables were grouped using principal component analysis in four different principal components (PC) that explained 90% of the total variance. The 4th PC predicted 24% of the percentage of change (∆%) of sCr and the 3rd PC predicted the ∆% of sALB by 23%. There were pre-and post-race large changes in sCr and sALB (p ≤ 0.01) and 33% of participants met acute kidney injury diagnosis criteria. (4) Conclusions: The data related to impacts could better explain the cumulative mechanical kidney trauma during mountain running, opening a new range of possibilities using technology to better understand how the number and magnitude of the g-forces involved in off-road running could potentially affect kidney function.
... Most of these cases were managed conservatively, except two AAST grade V injuries requiring nephrectomy. Again, no total sports-related or football-related kidney injuries were reported (Table 4) [31,32]. ...
Background:
Genitourinary injuries in athletes engaging in high-impact sports such as football and rugby may have catastrophic consequences, especially in individuals with pre-existing urologic concerns, such as a solitary kidney.
Objective:
To summarize the current literature on football-related or rugby-related genitourinary organ injuries in both adult and pediatric populations in an effort to risk stratify the likelihood of these injuries.
Methods:
An independent systematic literature search for records reporting football-related or rugby-related injuries was conducted by a certified librarian and reviewer in March 2019. The search electronic databases included Medline, EMBASE, Scopus, and Web of Science. All studies reporting football-related or rugby-related genitourinary injuries were included.
Results:
Twenty-two records (11 research studies, 11 case reports) were identified. In the pediatric population, the reported football-related kidney injuries were 0.1-0.7% of all football-related injuries, 0.07-0.5% of all sports-related injuries, and 1.5-37.5% of all sports-related genitourinary injuries, with incidence ranging from 0.00000084 to 0.0000092 injuries per exposure (five studies). Pediatric football-related testicular injuries were reported to be 0.11% of all football injuries, 0-0.07% of all sports-related injuries, and 0-37.5% of all sports-related genitourinary injuries; injury per exposure was 0.0000092 (four studies). In adults, there was no proportion of genitourinary injuries that could be determined, and football-related kidney injury incidence was 0.000012 injuries per exposure (one study). No adult literature investigated testicular injuries. Eleven case reports were additionally identified. Review of the case reports suggests that patients with previously existing urologic abnormalities such as ureteropelvic junction obstruction may predispose an individual to kidney injuries.
Conclusion:
There is little to suggest that those engaged in football or rugby have a significant risk of genitourinary injury; therefore, future guidelines should reflect this.
Background
Evidence is sparse regarding the incidence or prevalence of renal or genitourinary injuries arising from contact sports. There are currently no World Health Organization or European consensus guidelines relating to the participation in sport for children and young athletes with a solitary (functioning) kidney.
Purpose
To review the international literature and to make sport-specific recommendations for children and young athletes with a solitary (functioning) kidney participating in sports, based on the overall likelihood of potential renal or genitourinary injury.
Study Design
Narrative review; Level of evidence, 4.
Methods
A descriptive epidemiological study was conducted of current literature according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Embase, Google Scholar, Cochrane, and PubMed databases were queried from 1975 to 2023, to assess available evidence regarding the prevalence and risk of renal injury through sports participation and guidelines surrounding the participation in sports for children and young athletes with a solitary (functioning) kidney. Methodological quality and certainty of evidence were assessed according to the International Classification of Urological Disease guidelines.
Results
A total of 28 publications were identified after database searches and exclusions, comprising 40,889 patients. The majority of papers providing recommendations arose from the United States. Of the recommendations, 79% permitted an unrestricted return to noncontact sports. A return to contact sports is permitted in most instances after physician consultation.
Conclusion
There is a dearth of good-quality published evidence in the literature relating to sports participation with a solitary (functioning) kidney. Overall, the risk of genitourinary injury in sports is low, and after physician assessment, there is currently no strong evidence to exclude children and young athletes with a solitary (functioning) kidney from full participation in contact and collision sports.
The presentation of traumatic abdominopelvic injuries in sport can range from initially benign appearing to hemorrhagic shock. A high clinical suspicion for injury, knowledge of the red flags for emergent further evaluation, and familiarity with the initial stabilization procedures are necessary for sideline medical providers. The most important traumatic abdominopelvic topics are covered in this article. In addition, the authors outline the evaluation, management, and return-to-play considerations for the most common abdominopelvic injuries, including liver and splenic lacerations, renal contusions, rectus sheath hematomas, and several others.
