Kidney Injury: Insights on Hematoma, Function, and Recovery

Renal hemorrhagic atrophy?

Hello, doctor.
I was injured in a car accident at the end of July last year, which affected my left kidney and caused bleeding.
The hematoma was approximately 10 cm at that time.
I underwent two CT scans in the emergency room (one without contrast and one with contrast).
In February of this year, an ultrasound showed the hematoma had reduced to about 4 cm.
Over the past few months, due to blood pressure issues (135–150/85–100), there was a suspicion of renal artery stenosis, and the doctor performed another CT scan (with contrast).
Six months ago, my blood pressure was normal.
The scan indicated that the upper part of the left kidney had atrophied by about one-third, but the renal artery appeared to have no stenosis.
Prior to this, on February 4, the hospital conducted a blood test (non-fasting) showing creatinine at 0.82 and GFR at 78.
On February 8, a clinic blood test (fasting) showed creatinine at 0.72, GFR at 96.87, and BUN at 8.1.
A urinalysis indicated negative urine protein, 1 RBC, 0 WBC, and 15 epithelial cells.
My questions are as follows:
1.
Why is there such a significant difference in GFR values between the two blood tests? Do these values indicate chronic kidney disease? Is kidney function reversible?
2.
After more than six months, is there still a chance for the hematoma to shrink further? Will there be any long-term complications?
3.
Can kidney injuries affect the adrenal glands? If renal artery issues are ruled out, could this be related to the adrenal glands? What tests are needed? How long without controlled blood pressure can affect kidney function?
4.
Have the three CT scans (two with contrast) over six months caused further damage to kidney function?
5.
How often should I follow up in the future?
I have many questions, and I appreciate your patience in reading and answering them!

Eva, 30~39 year old female. Ask Date: 2021/02/26

Dr. Wu Jiyu reply Internal Medicine

1.
The current estimated glomerular filtration rate (eGFR) is calculated based on serum creatinine levels.
When eGFR is above 60, even a slight change in creatinine can lead to differences in eGFR, so regular follow-up is recommended.

2.
Hematomas have the potential to decrease in size, so regular monitoring is sufficient.

3.
Since the question mentioned that approximately one-third of the upper left kidney is atrophied, it cannot be ruled out that the adrenal gland may have been affected, which could influence blood pressure.
It is advisable to consult an endocrinologist or nephrologist for further blood tests to clarify the condition, and to manage blood pressure to ensure proper kidney function.

4.
Based on your mentioned kidney function, having undergone three CT scans (two with contrast) in the past six months has not significantly impacted your condition.

5.
Depending on stability, blood pressure should be monitored with follow-up visits every 1 to 3 months.
Thank you for your inquiry; the Nephrology Department at Changhua Hospital cares about your health.

Reply Date: 2021/02/26

More Info

I'm sorry to hear about your situation following the car accident. It sounds like you have been through a lot, and I appreciate your detailed questions regarding your kidney health. Let's address your concerns one by one.

1. GFR Variability: The difference in your GFR (Glomerular Filtration Rate) values can be attributed to several factors, including hydration status, time of day, and even the method of blood collection. GFR is calculated based on serum creatinine levels, and small fluctuations in creatinine can lead to significant changes in GFR, especially when values are near the threshold of normal. Your GFR values indicate that you are currently in the normal range, but the lower value (GFR of 78) could suggest some degree of kidney impairment. Chronic kidney disease (CKD) is diagnosed based on persistent abnormalities in kidney function over time, so it would be essential to monitor your kidney function regularly to determine if there is a trend toward deterioration or improvement.

2. Hematoma Resolution: Hematomas can take time to resolve, and it is possible for the size of the hematoma to decrease over time. The fact that it has reduced from 10 cm to 4 cm is a positive sign. However, the potential for further reduction depends on various factors, including your overall health, blood flow to the area, and whether there are any ongoing issues such as infection or inflammation. As for long-term effects, there can be complications such as chronic pain or renal function impairment, but many individuals recover well.

3. Adrenal Gland Injury: Kidney injuries can sometimes affect the adrenal glands, which are located on top of each kidney. If the injury was severe enough, it could potentially impact adrenal function. Blood pressure issues could be related to adrenal function, particularly if there is an adrenal injury leading to hormonal imbalances. To assess adrenal function, tests such as serum cortisol levels or an ACTH stimulation test may be performed.

4. Impact of Blood Pressure: Uncontrolled high blood pressure can indeed affect kidney function over time. If blood pressure remains elevated for an extended period, it can lead to further kidney damage. Regular monitoring and management of blood pressure are crucial to preserving kidney function.

5. CT Scans and Kidney Function: While CT scans can provide valuable information about kidney injuries, they do involve exposure to radiation and contrast agents, which can affect kidney function, particularly in individuals with pre-existing kidney issues. However, if your kidney function has remained stable and your doctors have deemed the scans necessary for diagnosis and management, the benefits may outweigh the risks. It is essential to discuss any concerns about the frequency of imaging with your healthcare provider.

6. Follow-Up Care: The frequency of follow-up appointments will depend on your specific situation and the recommendations of your healthcare team. Generally, after a significant kidney injury, follow-up every 3 to 6 months may be appropriate, but this can vary based on your recovery and any ongoing issues.

In summary, it is crucial to maintain open communication with your healthcare providers, who can tailor your follow-up and management plan based on your individual needs and health status. Regular monitoring of kidney function, blood pressure management, and addressing any symptoms or concerns promptly will be vital for your recovery. If you have further questions or concerns, do not hesitate to reach out to your medical team.

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