Good job, Isaiah! Your kidney is looking good!

We had a great visit today with the trauma surgeon.  He was delighted with what he saw on the ultrasound and will remain in the loop with the other doctors, but does not need to see us again at this point.

The ultrasound showed that his kidney no longer has the hematoma of blood surrounding it.  It did reveal that the lower 20% of the kidney was severed and has more than likely been disconnected from blood supply and has atrophied (begun to shrivel up).  The body will take care of it and, as is, will not effect him adversely at all.  The main section of the kidney looks great and seems to be working with adequate blood supply, etc.

The surgeon described to us for the first time something they suspected upon arrival to the hospital, but could not conclude for sure.  Isaiah's laceration (cut) on his kidney was so severe and blunt that when his kidney began to bleed the blood (hematoma) that filled in around his kidney filled every space possible and circled around the kidney to actually pinch off the ureter (see image below).  That is why they saw clear urine  during his first few days at the hospital, which often indicates the kidney has stopped bleeding.  However, his had not stopped leaking/bleeding, but rather filled the pocket surrounding the kidney with so much blood it simply cut off that kidney from draining urine into his bladder.  The urine we did see from him was only coming from his healthy kidney.

On day three of his hospital visit we knew he was not making progress or turning the corner that doctors look for.  We began discussing options with the resident overnight doctor.  That lead to more imaging and the determination that a stent was needed to assist the injured kidney so backed up urine was not mixing with blood.

The surgeon defers now to the pediatric urologist to decide when it is best to remove the stent. He feels that more time is better than less.  The stent has a time limit, but continues to be of use to the kidney, so the urologist will have to evaluate and make his best guess as to when to try the removal again.  We will speak with them tomorrow about what today's appointment revealed and go from there.

Once the surgery is confirmed the urologist will compare the contrast dye study to see if the leakage is less than it was in February.  If no change, then possibly they would need to do surgery to help the kidney seal up, but that would be the last resort if the stent was no longer a possible option.

When that surgery occurs it will help us know more about his kidney.  We can all only guess at how long it will take for the damaged tissue of his kidney to completely heal.  The best case scenario would be that the kidney will heal up completely with no leakage before the stent surgery so that once the stent is removed Isaiah can simply return to a normal lifestyle...with no more sledding accidents ;)

The surgeon drew a picture on the bed liner of the clinic office to explain things to us.  I wish I had taken a picture, but below are two drawings that are similar to his ;)