War-related Kidney Injuries

Increased intensity, changes in the nature of combat operations and development of munitions makes it important to study up-to-date information and improve methods of treatment of internal injuries, including those of the urinary system. Combat injuries to the genitourinary system account for 1-3% of all injuries. The kidneys are the most frequently injured, and among all injuries during military conflicts, kidney battle trauma (KBT) account for 1-5%, and according to statistics, in 80% of cases they are combined with internal organ damage. Kidney battle trauma is an isolated or combined injury to the kidney tissue with other internal organ involvement, acquired during hostilities and caused mainly by firearms, which is the main cause of penetrating injuries and is usually more serious and less predictable than blunt trauma. There are two groups of KBTs: closed (blunt) and open (penetrating or through). Open traumas, depending on the nature of the injury, can be bullet, shrapnel, stabbing, cutting, etc. According to the American Association for the Surgery of Trauma and the European Association of Urology, there are five degrees of severity of kidney damage. During war, medical care for the wounded begins on the battlefield on the principle of self- or mutual aid. Depending on the situation, it may include temporary bleeding control, administration of painkillers and antibiotics. The specifics of diagnosing and providing medical care as a result of a KBT depend on the intensity of hostilities at the frontline and the speed of evacuation of the wounded soldier to the appropriate medical facility. Military surgery is complex and unpredictable, requiring a multidisciplinary approach that should focus not only on the primary injury but also on possible and potentially life-threatening complications, such as wound infections. Analyzing the data obtained in the combat zone, it can be stated that kidney damage is one of the most common and serious problems among military personnel and civilians. The causes of such injuries range from direct exposure to blast waves and shrapnel to indirect injuries caused by landslides and other consequences of war. A timely and comprehensive approach to the diagnosis and treatment of kidney battle trauma, adapted to the specific conditions of military operations, is critical to preserving the lives and health of war victims.