The kidney is injured in about 1% of major trauma, and the majority of injuries result from blunt trauma.
Increasingly, and particularly in tertiary care hospitals, reconstruction of kidneys damaged by trauma, or only partial removal, replace total nephrectomy where possible 1.
Two healthy kidneys represent four times as much tissue as is minimally required for normal functioning. That is, 75% of kidney tissue is reserve.
It is for this reason that one of two healthy kidneys can be transplanted from a donor with impunity: the remaining healthy kidney increases in size and fulfils the role of two.
However, unrelated current or future disease of the remaining kidney ("thin skull") may, after post-traumatic nephrectomy, compromise health and require earlier, or otherwise unnecessary, dialysis and kidney transplantation.
|
PRACTICE POINT The clinical context of
post-traumatic removal of a kidney determines the prognosis and
quantum of damages
|
Similarly, injuries of other organs, spinal cord for instance, may have adverse effects on the future health of the remaining kidney.
Although there is insufficient data on prognosis after uncomplicated nephrectomy for trauma, outcome studies of kidney donors indicate an increased risk of mild hypertension and, perhaps, compromised kidney function 2, 3.
Living-related kidney donors have a materially better life expectancy than predicted, but this is probably because they are pre-selected at donation as being healthier than average. Kidney failure is not more common than usual as a cause of death 4.
Copyright © 2008 Electronic Handbook of Legal Medicine