Das stumpfe Nierentrauma: eine differenziertere Klassifikation als Grundlage einer stadiengerechten Therapie

Rassweiler, Jens; Eisenberger, F.; Buck, John R.; Miller, Kurt

doi:10.1055/s-2008-1062617

Cited by 10 publications

(11 citation statements)

References 22 publications

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“…Additional criteria for the severity of the renal damage were morphologic changes (contusions, ruptures, tears) and clinical symptoms (bleeding, urine extravasation, and loss of function). Their numbers varied from 0 to 21 (2 ϫ 4, 1 ϫ 5, 3 ϫ 6, 4 ϫ 7, 3 ϫ 8, 1 ϫ 9, 3 ϫ 10, 1 ϫ 12, 1 ϫ 14, and 2 ϫ 21) [3,6, (Balzer H, unpublished results).…”

Section: Resultsmentioning

confidence: 99%

“…After primary observation, the kidneys were less often removed (in 0.5-20%), but late complications were more frequent (in 20-40%). These included ischemic shrunken kidneys (in 4-40%), arterial hypertension (in 0.7-33%), and/or hydronephrotic urolithiasis (in 3-4%) [3][4][5][6][7]. Neither of these procedures has been investigated for their advantages and disadvantages in comparative studies.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Classification of Renal Injuries

Lent

2003

European Journal of Trauma

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Purpose: To assess whether previous classifications of renal injuries fulfill their purpose and to propose an alternative classification scheme. Material and Methods: In a retrospective analysis, papers that were published in the last 50 years and provided information on pathogenesis, localization, classification, treatment, and monitoring of the progress of renal injuries were evaluated with respect to the number or the frequency of severity grades and parenchymal ruptures, primary and secondary operations or nephrectomies, and early and late complications. Results: 24 papers were evaluated. These showed marked heterogeneity of all basal data and target parameters. The number of cases ranged from 40 to 510, the control periods from 5 to 29 years. The proportion of ruptures ranged from 11.2% to 100%, the percentage of cases treated operatively from 6.5% to 100%, of cases treated conservatively from 0 to 95.29%, of nephrectomies from 3.53% to 19.0%, and the rate of late sequelae/complications from 5.03% to 47.14%. There were seven classifications used with different frequencies, rankings, and criteria. In most of these, the morphologic injuries to the renal parenchyma were graded. The injuries to the renal pelvis-calyx system and the pedicle vessels were assigned without differentiation to a higher degree of severity. The prognostic and therapeutically decisive effects of the respective injuries -bleeding, urine extravasation, disorders of renal functionwere not taken into account at all. Conclusions: Previous classifications of renal injuries are based on anatomic changes without regard to their clinical consequences and degrees of severity. In the new classification scheme presented here, the injured organ systems (parenchyma, collecting system, pedicle vessels) and the existing symptoms of injury (bleeding, urine extravasation, disorders of renal function) are classified according to severity (slight, moderate, severe). Every injury can be defined using a simplified trauma formula (A B C -I II III) that expresses the severity, is relevant to decision-making, and provides advantages for practical emergencies and scientific comparisons.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical Classification of Renal Injuries

Lent

2003

European Journal of Trauma

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“…Where- Table 2. Classification of renal trauma in accordance with patho genesis (P 1-2), location and degree of injury (LA 0-7, B 0-2, C 0-9) and symptoms as prognostic factors (SA 0-3, B 0-3, C 0- 3) as the most frequently occurring lesions of the parenchy ma are at the forefront of interest, the rarer injuries to the renal pelvis and the vascular system are categorized with the degrees of severity II to VI in most classifications. Although this appears to be entirely practicable in many cases, especially involving blood vessels there are in real ity different injuries with different degrees of severity [19,30].…”

Section: Discussionmentioning

confidence: 99%

“…These are: ( 1 ) differences in the trauma genesis (traffic, work, sport, criminal activity); (2) differences in trauma diagnostics (sonography, urography, computer to mography, angiography); (3) differences in trauma man agement (surgery, urology), and (4) differences in trauma evaluation (classification of the degrees of severity of [2][3][4][5][6] Results A total of 24 classifications published from 1896 or between 1950 and 1991 was evaluated (table 1). Of these, 13 (54.2%) did not contain any distinction between blunt and perforating injuries, 9 (37.5%) related exclusively to blunt injuries and only two (8.3%) solely to perforating injuries.…”

Section: Introductionmentioning

confidence: 99%

“…At least seven and at most 20 criteria were not considered on Numerous classifications for renal injuries have been presented in the literature in the past 50 years. These are oriented to different criteria such as: (1) the pathogenesis (closed or open injury); (2) the morphological findings (type and degree of ruptures), and (3) the clinical course (nature and time course of symptoms) [2,3,.…”

Section: Introductionmentioning

confidence: 99%

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