Injury - kidney and ureter
Kidney damage; Toxic injury of the kidney; Kidney injury; Traumatic injury of the kidney; Fractured kidney; Inflammatory injury of the kidney; Bruised kidney; Ureteral injury; Pre-renal failure - injury; Post-renal failure - injury; Kidney obstruction - injuryInjury to the kidney and ureter is damage to the organs of the upper urinary tract.
Causes
The kidneys are located in the flank at either side of the spine. The flank is the back of the upper abdomen. They are protected by the spine, lower rib cage, and strong muscles of the back. This location protects the kidneys from many outside forces. The kidneys are also surrounded by a layer of fat. The fat helps to cushion them.
The kidneys have a large blood supply. Any injury to them, can lead to severe bleeding. The many layers of padding help prevent kidney injury.
Kidneys may be injured by damage to the blood vessels that supply or drain them, including:
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Aneurysm
Aneurysm
An aneurysm is an abnormal widening or ballooning of a part of an artery due to weakness in the wall of the blood vessel.
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Arterial blockage
Arterial blockage
Arterial embolism refers to a clot (embolus) that has come from another part of the body and causes a sudden interruption of blood flow to an organ o...
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Fistula
A fistula is an abnormal connection between two body parts, such as an organ or blood vessel and another structure. Fistulas are usually the result ...
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Renal vein thrombosis (clotting)
Renal vein thrombosis
Renal vein thrombosis is a blood clot that develops in the vein that drains blood from the kidney.
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Kidney injuries may also be caused by:
- Angiomyolipoma, a noncancerous tumor, if the tumor is very large
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Autoimmune disorders
Autoimmune disorders
An autoimmune disorder occurs when the body's immune system attacks and destroys healthy body tissue by mistake. There are more than 80 autoimmune d...
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- Cancer of the kidney, pelvic organs (ovaries or uterus in women), or colon
- Diabetes
- Buildup of body waste products such as uric acid (which can occur with gout or treatment of bone marrow, lymph node, or other disorders)
Gout
Gout is a type of arthritis. It occurs when uric acid builds up in the blood and causes inflammation in the joints. Acute gout is a painful conditio...
Read Article Now Book Mark Article - Exposure to toxic substances such as lead, cleaning products, solvents, fuels, certain antibiotics, or long-term use of pain medicines (analgesic nephropathy)
Analgesic nephropathy
Analgesic nephropathy involves damage to one or both kidneys caused by overexposure to mixtures of medicines, especially over-the-counter pain medici...
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- Inflammation caused by immune responses to medicines, infection, or other disorders
- Medical procedures such as kidney biopsy, or nephrostomy tube placement
Kidney biopsy
A kidney biopsy is the removal of a small piece of kidney tissue for examination.
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Ureteropelvic junction obstruction
Ureteropelvic junction obstruction
Ureteropelvic junction (UPJ) obstruction is a blockage at the point where part of the kidney attaches to one of the tubes to the bladder (ureters). ...
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- Kidney stones
The ureters are the tubes that carry urine from the kidneys to the bladder. Ureteral injuries may be caused by:
- Complications from medical procedures
- Diseases such as retroperitoneal fibrosis, retroperitoneal sarcomas, or cancers that spread to the lymph nodes near the ureters
Retroperitoneal fibrosis
Retroperitoneal fibrosis is a rare disorder that blocks the tubes (ureters) that carry urine from the kidneys to the bladder.
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Radiation to the belly area
Radiation
Radiation therapy uses high-powered radiation (such as x-rays or gamma rays), particles, or radioactive seeds to kill cancer cells.
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Symptoms
Emergency symptoms may include:
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Abdominal pain and swelling
Abdominal pain
Abdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly.
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Blood in the urine
Blood in the urine
Blood in your urine is called hematuria. The amount may be very small and only detected with urine tests or under a microscope. In other cases, the...
Read Article Now Book Mark Article - Drowsiness, decreased alertness, including coma
Decreased alertness
Decreased alertness is a state of reduced awareness and is often a serious condition. A coma is the most severe state of decreased alertness from whi...
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- Fever
- Increased heart rate
- Nausea, vomiting
- Skin that is pale or cool to touch
- Sweating
Long-term (chronic) symptoms may include:
- Malnutrition
- High blood pressure
- Kidney failure
If only one kidney is affected and the other kidney is healthy, you may not have any symptoms.
Exams and Tests
The health care provider will examine you. Let them know about any recent illness or if you have come into contact with toxic substances.
The exam may show:
- Excess bleeding (hemorrhage)
- Extreme tenderness over the kidney
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Shock, including rapid heart rate or falling blood pressure
Shock
Shock is a life-threatening condition that occurs when the body is not getting enough blood flow. Lack of blood flow means the cells and organs do n...
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Tests that may be done include:
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Abdominal CT scan
Abdominal CT scan
An abdominal CT scan is an imaging method. This test uses x-rays to create cross-sectional pictures of the belly area. CT stands for computed tomog...
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Abdominal MRI
Abdominal MRI
An abdominal magnetic resonance imaging scan is an imaging test that uses powerful magnets and radio waves. The waves create pictures of the inside ...
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Angiography of the kidney artery or vein
Angiography
Renal arteriography is a special x-ray of the arteries of the kidneys.
Read Article Now Book Mark Article - Blood electrolytes
Electrolytes
Electrolytes are minerals in your blood and other body fluids that carry an electric charge. Electrolytes affect how your body functions in many ways...
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- Complete blood count (CBC)
CBC
A complete blood count (CBC) test measures the following:The number of white blood cells (WBC count)The number of red blood cells (RBC count)The numb...
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IVP
An intravenous pyelogram (IVP) is a special x-ray exam of the kidneys, bladder, and ureters (the tubes that carry urine from the kidneys to the bladd...
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Kidney x-ray
Kidney x-ray
An abdominal x-ray is an imaging test to look at organs and structures in the abdomen. Organs include the liver, spleen, stomach, and intestines. Wh...
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Renal scan
Renal scan
A renal scan is a nuclear medicine exam in which a small amount of radioactive material (radioisotope) is used to measure the function of the kidneys...
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Urinalysis
Urinalysis
Urinalysis is the physical, chemical, and microscopic examination of urine. It involves a number of tests to detect and measure various compounds th...
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- Voiding cystourethrogram
Treatment
The goals are to treat emergency symptoms and prevent or treat complications. You may need to stay in a hospital.
Treatments for a kidney injury may include:
- Bed rest for 1 to 2 weeks or until bleeding is reduced
- Close observation and treatment for symptoms of kidney failure
- Diet changes
- Medicines to treat damage caused by toxic substances or illnesses (for example, chelation therapy for lead poisoning or allopurinol to lower uric acid in the blood due to gout)
- Pain medicines
- Eliminating medicines or exposure to substances that may have injured the kidney
- Drugs such as corticosteroids or immunosuppressants if the injury was caused by inflammation
- Treatment of acute kidney failure
Sometimes, surgery is needed. This may include:
- Repairing a "fractured" or torn kidney, torn blood vessels, torn ureter, or similar injury
- Removing the entire kidney (nephrectomy), draining the space around the kidney, or stopping the bleeding via arterial catheterization (angioembolization)
Nephrectomy
Kidney removal, or nephrectomy, is surgery to remove all or part of a kidney. It may involve:Part of one kidney removed (partial nephrectomy). All o...
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- Removing blockage or relieving obstruction
Outlook (Prognosis)
How well you do depends on the cause and severity of the injury.
Sometimes, the kidney starts working properly again. Sometimes, kidney failure occurs.
Possible Complications
Complications may include:
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Sudden kidney failure, one or both kidneys
Sudden kidney failure
Acute kidney failure is the rapid (less than 2 days) loss of your kidneys' ability to remove waste and help balance fluids and electrolytes in your b...
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- Bruising of the kidney
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Chronic kidney failure, one or both kidneys
Chronic kidney failure
Chronic kidney disease is the slow loss of kidney function over time. The main job of the kidneys is to remove wastes and excess water from the body...
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Peritonitis
Peritonitis is an inflammation (irritation) of the peritoneum. This is the thin tissue that lines the inner wall of the abdomen and covers most of t...
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Sepsis is an illness in which the body has a severe, inflammatory response to bacteria or other germs.
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- Renal artery stenosis
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Renal hypertension
Renal hypertension
Renovascular hypertension is high blood pressure due to narrowing of the arteries that carry blood to the kidneys. This condition is also called ren...
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Shock
Shock
Shock is a life-threatening condition that occurs when the body is not getting enough blood flow. Lack of blood flow means the cells and organs do n...
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Urinary tract infection
Urinary tract infection
A urinary tract infection, or UTI, is an infection of the urinary tract. The infection can occur at different points in the urinary tract, including...
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When to Contact a Medical Professional
Contact your provider if you have symptoms of an injury to the kidney or ureter. Contact the provider if you have a history of:
- Exposure to toxic substances
- Illness
- Infection
- Physical injury
Go to the emergency room or call 911 or the local emergency number if you have decreased urine output after a kidney injury. This may be a symptom of kidney failure.
Prevention
You can help prevent injury to the kidneys and ureter by taking these steps:
- Be aware of substances that can cause lead poisoning. These include old paints, vapors from working with lead-coated metals, and alcohol distilled in recycled car radiators.
- Take all your medicines properly, including ones you buy without a prescription (over-the-counter).
- Treat gout and other illnesses as instructed by your provider.
- Use safety equipment during work and play.
- Use cleaning products, solvents, and fuels as directed. Make sure the area is well-ventilated, because the fumes may also be toxic.
- Wear seat belts and drive safely.
References
Brandes SB, Eswara JR. Upper urinary tract trauma. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 90.
Breyer BN, Cohen AJ. Retroperitoneal injuries: kidney and ureter. In: Cameron AM, Cameron JL, eds. Current Surgical Therapy. 13th ed. Philadelphia, PA: Elsevier; 2020:1197-1203.
Okusa MD, Portilla D. Pathophysiology of acute kidney injury. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 28.
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Kidney anatomy - illustration
The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and the stimulation of red blood cell production.
Kidney anatomy
illustration
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Kidney - blood and urine flow - illustration
This is the typical appearance of the blood vessels (vasculature) and urine flow pattern in the kidney. The blood vessels are shown in red and the urine flow pattern in yellow.
Kidney - blood and urine flow
illustration
-
Kidney anatomy - illustration
The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and the stimulation of red blood cell production.
Kidney anatomy
illustration
-
Kidney - blood and urine flow - illustration
This is the typical appearance of the blood vessels (vasculature) and urine flow pattern in the kidney. The blood vessels are shown in red and the urine flow pattern in yellow.
Kidney - blood and urine flow
illustration
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Kidney stones - InDepth
(In-Depth)
Review Date: 7/4/2022
Reviewed By: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.