The diagnosis came at the end of 2025, after an intense match against La Rochelle: Romain Ntamack suffered from a crack in the fibrous capsule of the kidney.
A brutal shock during a tackle
If the term can be frightening, it designates a specific lesion of the protective envelope of the organ. For Dr Gérald Kierzek, the mechanism is typical of contact sports.
“The fissure of the fibrous capsule of the kidney is a limited traumatic rupture of this fibrous capsule surrounding the kidney, without deep parenchymal damage or significant hematoma. It typically results from a direct abdominal or lumbar impact during a violent tackle, with compression of the kidney against the lower ribs or the spine”
What is the role of this renal “capsule”?
The kidney is not “bare” in the abdomen. A layer of fibrous tissue protects it. It is made up of collagen and elastin, located just under the perirenal fat. This membrane has a dual mission: it serves as a barrier against infections and supports the mass of the organ to keep it in place.
When we speak of a “fissure”, the lesion remains partial. Less serious than complete rupture, it requires absolute vigilance to prevent the kidney itself from being permanently damaged.
Pain and hematuria: warning signs
The most dramatic symptom of such trauma is often the presence of blood in the urine, called hematuria. Dr Kierzek clarifies the clinical picture.
“There is sudden unilateral lower back pain, radiating towards the flank or abdomen, often described as a “stabbing”. Macroscopic hematuria, with pink or red urine, appears in 70 to 80% of cases quickly after the trauma.“.
The diagnosis is then based on precise imaging, generally an abdominopelvic scan with injection, which makes it possible to check the extent of the damage and the absence of urine leakage into the abdomen.
A treatment based on rest and patience
Fortunately, surgery remains the exception for this type of crack. In 90 to 95% of cases, treatment is “conservative”. It is based on strict bed rest, ample hydration and monitoring the color of urine.
“The majority of capsular fissures resolve spontaneously within 2 to 4 weeks without sequelae. The prognosis is excellent for isolated injuries: return to rugby is possible after 1 to 3 months with initial lumbar protection.” reassures Dr. Kierzek.
Romain Ntamack could set foot on the pitch during Toulouse’s next match against Montauban, but everything will depend on his physical condition and the opinion of the doctors at Stade Toulousain.