Grade IV Renal Injuries: Evaluation, Treatment, and Outcome

Abstract

Of our last 2483 renal trauma patients, 113 had grade IV injuries. In most the mechanism was a penetrating injury (60%: 30% gunshot, 30% stab wounds). Associated injuries were common (80%) and hospital stays prolonged, averaging 16 days. Most of the patients (70%) required transfusion, some massively (average volume 4.4 liters, range 0-30 liters). Surprisingly, not all patients with grade IV renal injuries had gross hematuria: 25% had microhematuria, and 4% had neither microscopic nor gross hematuria. Computed tomography (CT) diagnosed the injury correctly in 100% of the patients in whom it was performed; when CT was not available, "one-shot" intraoperative intravenous pyelography (IVP) demonstrated grossly abnormal findings in 90%. Renal exploration was performed in 78%, resulting in 69% renorrhaphy and 9% nephrectomy rates in our 113 patients. Almost all those with penetrating trauma required exploration (97%), whereas only 50% of those with blunt trauma did so. The overall complication rate and kidney-specific complication rate did not differ significantly between patients who were observed and those who underwent surgery. Complications rates were similar in grade IV renal laceration patients and grade III patients. Delayed complications after hospital discharge were not seen, although follow-up was rare in this inner-city trauma population. Among the 21% of patients in whom postoperative nucleotide renal function scans were available, function was generally good (average 36%). Only patients who underwent concomitant vascular repair had poor function (below 20%).

Is Accompanying Organ Damage Related with Mortality in Renal Trauma?

“…In our study, no surgical procedure was performed for the patients with grade 1-2-3 renal traumas, and all of these patients had a successful recovery through conservative treatment. Conservative treatment is contraindicated in cases where there is a hemodynamic instability due to bleeding and a developing pulsatile retroperitoneal hematoma as well as ongoing hypotension despite the transfusion and suspicion of the renal pelvis and ureteral injury [17,18]. In a study by Santucci et al (17).…”

“…Conservative treatment is contraindicated in cases where there is a hemodynamic instability due to bleeding and a developing pulsatile retroperitoneal hematoma as well as ongoing hypotension despite the transfusion and suspicion of the renal pelvis and ureteral injury [17,18]. In a study by Santucci et al (17). 78% of patients with grade 4 trauma were received renal exploration, and renography and nephrectomy were performed for 69% and 9% of them.…”

Diagnosis value of multi-slice spiral CT in renal trauma

“…Medical management depends on the grades of renal trauma. Recent studies showed that majority of low grade of renal trauma can be conservatively treated while high grade injure often needs surgery [17]. Up to 88% of patients with grade III and 78% of grade IV had conservative treatment; while 91% of grade V injuries needed the surgical management.…”

Current Approachs to Urogenital System Injuries in High Energy Trauma Exposed

“…Yatak istirahatı ile destekleyici bakım ve gözlem stabil hastalar için yeğlenen tedavi yöntemidir ve morbiditede herhangi bir artış olmaksızın daha düşük bir nefrektomi oranı ile ilişkilidir. 4. ve 5. derece yaralanmalarda hasta yüksek ekplorasyon, nefrektomi ve komplikasyon oranlarına sahip olmakla birlikte, stabil hastalarda başlangıçta konservatif bir yaklaşım uygulanabilir (23) . Soliter yaralanmalarda idrarla ekstravazasyon tanısı alan hastalar, %90'ın üzerinde bir oran ile büyük bir müdahale olmadan tedavi edilebilir (24) .…”