Alex Khokhlachev practicing his "Holy crap, I just lacerated a kidney!" face.

 

It’s not unusual for a player’s season to be ended by an injury. Concussions, knee blowouts, broken bones, lacerated organs. Yes, seriously. Windsor Spitfire/Bruins pick Alex Khokhlachev left a game (and the rest of the OHL season) on Saturday after a hit in the first period resulted in a kidney laceration. While not incredibly rare in the world of traumatic injuries, this isn’t something that often crops up in hockey.

The Kidney: You need at least one.

You probably don’t think about your kidneys much, and that’s fine as long as they’re working. They filter junk out of your blood and into your urine (which they produce), they regulate your electrolytes, salt and water balances, and they produce some pretty important hormones (like the one that tells your body to produce red blood cells). The kidneys are fairly well protected by virtue of the fact that they’re retroperitoneal organs (squirreled away in the back of your abdominal cavity), and partially hidden by your ribs. Reach behind yourself and give your ribs a good grope. Where those ribs end is more or less where your kidneys live. Yes, they’re way up there. Next time that butthead in rec league crosschecks you in what he thinks are your kidneys, go ahead and feel superior knowing that he’s actually just whacking you in the ass (what kind of messed up rec league do you play in???).

 

This kickass picture demonstrates why your kidneys aren't too easy to hurt. And now you also know where your pancreas is.*

 

* One of the first things they teach you in surgery (and reiterate frequently): DON’T $#@% WITH THE PANCREAS. And now you know.

Kidneys have the somewhat rare distinction of being a paired organ, meaning that if you lose one you can generally coast along nicely with the leftover. See also: testicles, lungs, ovaries (or just take my word for it). They’ve got a whole bunch of fat around them, and they’re both surrounded by a renal capsule – a tough layer of badassery that makes them pretty resilient. All that protection is no accident, since the blood supply for the kidneys comes right off the aorta (the giant blood vessel that takes the blood from your heart to the rest of your body), and the greedy little buggers use about 20% of the heart’s output. Seeing as how one of their major jobs is to filter crud out of the blood, kidneys are very vascular (they’re crammed full of little arteries and veins). The upshot of all of that is that although they’re hard to hurt, they’ll bleed like stink if given half the chance.

 

How to lacerate a kidney:

Although getting stabbed in one is the most obvious way to lacerate a kidney, it’s not the most common. That distinction belongs to blunt trauma, which comes in a couple of different flavours – deceleration injuries or direct blows. Deceleration injuries happen when your body stops suddenly (think car accident) and the sloshy bits inside of it keep going until something stops them – remember how the inside of the skull can stop the brain and cause an injury? All that junk inside your abdomen can get injured in much the same way (minus the part about the skull). Direct blows are pretty self-explanatory. Get whacked in the kidney, kidney gets broken. The end.

In Khokhlachev’s case, either mechanism is a possibility. He went down after taking a hit from behind and then running into another player. Hockey hits aren’t exactly low-velocity so there could certainly be an element of acceleration/deceleration at work. The direct blow possibility is screamingly obvious in this situation. Hockey gear definitely has protection gaps, but between the height of the pants, the length of the chest/shoulder pads, and his own ribs it’s a pretty crazy fluke that this injury actually happened.

 

How to tell if your kidney is lacerated:

Sometimes obvious things are obvious:

- It hurts

- You’re peeing blood

- Someone stabbed you in it

Sometimes it’s not so obvious. Trauma patients generally find themselves at the receiving end of a FAST exam (focused abdominal sonogram for trauma – an ultrasound that looks for free fluid in the abdomen), and/or a CT scan. There are other imaging modalities (like the IV pyelogram – a series of special x-rays of the kidneys and urinary system) out there, but the CT scan is practically standard in trauma now, and tells you what you need to know as regards a need for surgery (or not).

 

How to treat your lacerated kidney:

Kidney lacerations are staged according to severity, and the treatment depends on the grade:

Grade 1: Basically a bruised kidney. Not a huge deal.

Grade 2: A little bit of blood around the kidney (but no active bleeding), and/or a small kidney laceration (less than 1cm), but no pee leakage.

Grade 3: A laceration bigger than 1cm but no leaking pee.

Grade 4: A laceration causing pee leakage, and/or an injury to a major vessel in/supplying the kidney.

Grade 5: Shattered kidney, kidney knocked right off of all the important tubes that carry things to and from it (blood, pee), kidney whose artery is screwed all the way up. PANIC TIME.

A kidney that’s not still bleeding and whose blood supply is intact can usually be left alone to heal without surgery. The ones that don’t do well without operative management are the ones that won’t stop bleeding, whose main vein or artery is severed, the shattered ones, and ones with a lot of dead parts. Obviously this is a massive oversimplification of renal trauma management, but the takeaway message is that most kidney injuries (of blunt force origin and with bleeding under control) are successfully treated non-operatively.

 

What’s ahead for Khokhlachev?

His season is definitely over. Even if his kidney laceration is being treated non-operatively, HE STILL HAS A KIDNEY LACERATION. That’s not the sort of thing you’d want to be playing hockey with. Assuming his pain is controlled and he’s peeing okay he won’t have to stay in the hospital, and he’s looking to be out of action for (standard medical answer!) a minimum of about eight weeks. Complications are unlikely in someone this young and healthy, assuming he behaves himself and stays out of situations that could reinjure his lacerated kidney before it has a chance to heal. Looking ahead, there’s no reason this should affect him at all beyond the immediate time needed to heal. The same sadly can’t be said for his Windsor Spitfires, who are flirting with the basement of the OHL Western Conference. Too bad their leading scorer and only NHL draftee has that pesky lacerated kidney.