Renal trauma: evaluation, management, and return to play.

Area of Science:

• Sports Medicine
• Nephrology
• Trauma Surgery

Background:

• Renal injuries in athletes stem from both traumatic and atraumatic causes.
• Atraumatic injuries like exercise-induced proteinuria and hematuria typically resolve without long-term kidney damage.
• Traumatic injuries result from blunt or penetrating trauma, with microscopic hematuria being a common indicator.

Purpose of the Study:

• To review the mechanisms and management of renal injuries in athletes.
• To highlight the diagnostic approach for exercise-related and traumatic kidney injuries.
• To assess the risk of kidney loss in athletes with a solitary kidney.

Main Methods:

• Review of literature on athletic participation and renal injury.
• Discussion of diagnostic findings, including hematuria and proteinuria.
• Application of the American Association for the Surgery of Trauma (AAST) kidney injury scale.

Main Results:

• Exercise-induced renal abnormalities usually resolve spontaneously.
• Further imaging for traumatic kidney injury is often unnecessary without hypotension or gross hematuria.
• The AAST scale aids in determining the need for advanced work-up and surgical intervention.
• Athletes with a solitary kidney demonstrate a low risk of kidney loss during sports participation.

Conclusions:

• Most exercise-related renal issues in athletes are transient and benign.
• Conservative management is appropriate for many renal injuries in athletes, guided by clinical presentation and the AAST scale.
• Athletes with a solitary kidney can generally participate safely in sports.