ABSTRACT
Answer:(e) Thepresenceofgrosshematuria disproportionate to the severity of the history of the traumatic injury classically suggests that a preexisting renal anomaly is present. Specifically, genitourinary (GU) anomalies found with this history in order of decreasing frequency are UPJ obstruction, hydroureteronephrosis (refluxing, obstructive or nonobstructive-nonrefluxing variants), and renal fusion anomalies (horseshoe kidneys). Approximately 30% of patients with UPJ disruption will have no degree of hematuria, with the vast majority of patients with a UPJ disruption having severe life-threatening associated injuries which resulted in inadequate radiographic staging studies being performed. The presence of multiple life-threatening injuries and the need for emergent life-saving surgery results in inadequate radiographic staging, leading to a missed or delayed diagnosis of the UPJ disruption in >50% of patients.
