Features and outcomes of patients with grade IV renal injury

Abstract

OBJECTIVE To evaluate the clinical features and outcomes of patients who presented with grade IV renal trauma to our urban level I trauma hospital and to further refine the absolute indications for exploration and determine the outcomes of conservative management. PATIENTS AND METHODS In all, 77 patients with grade IV traumatic renal injuries presented to our emergency department between October 1997 and October 2006. A prospective trauma database including these patients was analysed to determine the patterns of injury, operative outcomes and complications. RESULTS A quarter of the patients had gunshot injuries, 9% had stab injuries, and 66% had blunt traumas. In all, 36% of patients required surgical exploration to treat associated non‐urological injuries. There was no or microscopic haematuria in 29% of the patients. Of the 32 patients who underwent renal exploration, 63% (20/32) underwent renorrhaphy and 37% (12/32) underwent nephrectomy. In multivariate analyses, only gunshot injury, surgery for non‐urological injury, and volume of blood transfused were significantly associated with the need for renal exploration (P = 0.015, P = 0.041, and P = 0.032, respectively). The renal complication rate was higher in patients managed conservatively vs those who underwent surgical exploration, but this was not statistically significantly different (28% vs 13%, P = 0.2). Hospital stay was longer after renal exploration than after conservative management at a median of 12 days vs 7 days (P = 0.01). CONCLUSIONS While almost all patients with penetrating injury require renal exploration, only 20% of those with blunt trauma do. Patients with no renal injuries and/or haemodynamic instability are more likely to require exploration. Finally, the rate of complications was not statistically different according to management type (conservative vs renal exploration).

Successful Nonoperative Management of the Most Severe Blunt Renal Injuries

“…Nephrorrhaphy was associated with the highest rate of complications. Similarly, Shariat et al 26 showed nonsignificantly different rates of complications between NOM patients (28%) and IO patients (13%) with grade IV BRIs. Obviously, these results may be misleading because renal-related complications are harder to develop after nephrectomy, and one could argue that the ultimate complication is the loss of the kidney.…”

Blunt renal trauma in children: a retrospective analysis of 41 cases

“…[1,4] Son yıllarda, tanı ve takip yöntemlerinin gelişmesi ve bu konuda hekimlerin tecrübelerin artmasıyla daha az invaziv tedavi yöntemleri kullanılmaya başlanmıştır. [4] Solid organ yaralanmalarındaki ameliyatsız yöntemle tedavinin başarı oranları günümüzde %90'ların üzerine çıkmıştır.…”

“…[1,4] Son yıllarda, tanı ve takip yöntemlerinin gelişmesi ve bu konuda hekimlerin tecrübelerin artmasıyla daha az invaziv tedavi yöntemleri kullanılmaya başlanmıştır. [4] Solid organ yaralanmalarındaki ameliyatsız yöntemle tedavinin başarı oranları günümüzde %90'ların üzerine çıkmıştır. [8][9][10] 1951 yılında King ve Schumacker'in postsplenektomi sepsisini göstermeleri ve çocuk cerrahlarının dalağı mümkün olduğun-ca koruma çalışmalarıyla başlayan bu süreçte başlangıçta çe-şitli kısıtlamalara neden olan belirsizlikler ve kuşkular her gün çoğalan başarılı sonuçların görülmesiyle artık kaybolmuştur.…”

“…[3] Böbrek yaralanmalarında ilk tedavi seçeneği konservatif olmakla birlikte yüksek dereceli yaralanmalarda ve idrar ekstravazasyonun olduğu durumlarda tartışmalıdır. [2,[4][5][6][7] Bu çalışmada, KBY nedeniyle takip edilen olgular, klinik bulguları ve tedavi yaklaşımları açısında değerlendirildiler. Künt böbrek yaralanmaları olguların %58.5'de yüksekten düş-me (n=24), %36.6'da trafik kazası (n=15) ve %4.9'da diğer (at tepmesi) (n=2) nedenlerden dolayı meydana gelmişti.…”

Guideline of guidelines: a review of urological trauma guidelines

“…Contrarily, the AUA recommends observation for hemodynamically stable patients regardless of AAST grade, due to interobserver variability regarding classification of grade 4 and 5 injuries (Grade B, AUA). With the increasing evidence of excellent outcomes of conservative management for correctly classified grade 4 injuries [16,17], there have been proposals to re-classify grade 4 and 5 injuries [18,19]; this would clarify the ambiguities of defining these injuries and may allow for more successful management decisions.…”