Kidney injuries from sports often occur in isolation

Salt Lake City-Sports-related high-grade renal injuries occurred more often in isolation from other abdominal organ injury and without associated hemodynamic instability as compared with nonsports renal trauma, a statewide review of traumatic renal injuries showed.

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Overall, sporting incidents accounted for 30% of high-grade renal injuries seen over a 6-year period at level 1 trauma centers in Utah. A majority of the sport-related renal trauma resulted from snow sports.

Renal trauma due to sporting incidents had a severity level similar to that of nonsports-related high-grade renal injuries but required intervention less often, first author Jeffrey Redshaw, MD, reported at the 2014 AUA annual meeting in Orlando, FL.

“The findings supported our hypothesis that sports-related renal injuries would not be associated with polytrauma,” Dr. Redshaw told Urology Times.

“Patients with sports-related renal injuries tended not to have tachycardia and they weren’t hypotensive, which are signs that are often associated with renal trauma,” added Dr. Redshaw, a urology resident at the University of Utah, Salt Lake City, who worked on the study with Jeremy B. Myers, MD, and colleagues.

The American Association for the Surgery of Trauma (AAST) defines high-grade renal injuries as grade III-IV. Motor vehicle accidents account for a majority of high-grade renal trauma, usually occurring in the setting of polytrauma involving numerous concomitant injuries.

In contrast to motor vehicle-associated renal trauma, sports-related injuries usually involve a solitary blow to the flank or abdomen.

Because of the different circumstances between sports-related and nonsporting renal trauma, Dr. Redshaw and colleagues hypothesized that sports-related high-grade renal injuries would be less likely to involve polytrauma. To test the hypothesis, they retrospectively reviewed medical records of patients with high-grade renal injuries treated at Utah trauma centers from 2005 to 2011.

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The analysis included 138 patients identified as having AAST III-IV renal injuries. Sporting activities accounted for 42 (30%) of the injuries. Skiing and snowboarding accounted for 26 sports-related renal trauma incidents (62%). Most of the remaining sports-related injuries involved individual contact during a sporting activity, such as football or cycling. The investigators excluded renal injuries associated with snowmobile and all-terrain vehicle accidents, considering them more closely related to motor vehicle injuries.

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Males dominate sports-related injuries

The AAST mean renal grade was 3.5 for sports-related renal injuries and 3.7 for nonsports-related injuries (p=.08). Male patients predominate in renal trauma, and the predominance increased in the sports-related renal injuries (90.5% vs. 61% of nonsports injuries, p<.001).

Sports-related renal injuries were associated with a mean injury severity score (ISS) of 12.6, whereas patients with nonsports renal trauma had a mean ISS of 27.3 (p<.001). Sports-related renal trauma was more than twice as likely to occur in isolation from injury to other abdominal organs (78% vs. 36%, p<.001). Signs of hemodynamic instability (such as hypotension or tachycardia) were observed in 47.6% of patients with sports-related renal trauma compared with 67% of patients with nonsports-related renal trauma (p=.037).

Almost twice as many patients with nonsports injuries required secondary interventions as compared with patients who had sports-related renal trauma (20% vs. 11.9%), although the difference did not reach statistical significance (p=.332).

“Statewide, sports-related renal injuries accounted for 30% of all high-grade renal trauma, which surprised us, because we did not think the percentage would be that high. We were also surprised to see that males made up more than 90% of all sports-related renal injuries. Overall, males account for a majority of high-grade renal injuries, but the proportion was much higher for sports-related injuries than for nonsports-related injuries,” said Dr. Redshaw.

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