Management of High-grade Blunt Renal Trauma

Lee, Min A; Jang, Myung Jin; Lee, Gil Jae

doi:10.20408/jti.2017.30.4.192

Cited by 7 publications

(7 citation statements)

References 16 publications

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“…Blunt trauma to the abdomen, flank, or back is the most common mechanism of injury [1]. Blunt trauma is reported to be the cause of the majority of cases (80-95% of all renal trauma) and mostly occurs due to traffic accidents [6,11]. However, in the military community and large cities, the prevalence of penetrant renal trauma can reach 20% or more [8].…”

Section: Introductionmentioning

confidence: 99%

“…However, in the military community and large cities, the prevalence of penetrant renal trauma can reach 20% or more [8]. Many blunt renal traumas are in the low-grade classification, and 80-85% of these cases can be treated with non-operative management (NOM) [11]. Renal trauma is often associated with injury to other major organs [5] and occurs in 3% of patients who are hospitalized due to trauma [10].…”

Section: Introductionmentioning

confidence: 99%

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Renal trauma: a 5-year retrospective review in single institution

et al. 2020

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Background Renal trauma occurs in up to 5% of all trauma cases and accounts for 24% of abdominal solid organ injuries. Renal trauma management has evolved over the past decades, and current management is transitioning toward more conservative approaches for the majority of hemodynamically stable patients. The objective of this study was to analyze the mechanism of injury, management, and outcome in renal trauma. Methods Patients diagnosed with renal trauma in Makassar, Indonesia, from January 2014 to December 2018 were identified retrospectively by the ICD-10 code. Data were collected from medical records. Imaging was classified by radiologists. Variables analyzed included age, sex, mechanism of injury, degree of renal trauma, related organ injury, management, and outcome. Results Out of the 68 patients identified, the average age was 23.9 ± 0.6 years, and most were male (83.8%). Blunt trauma accounted for 89.7% of all cases. The most common renal injuries were grade IV (42.6%), and 14% of the cases had no hematuria. Most patients were treated with non-operative management (NOM). Nephrectomy was performed in 16.2% of cases, and 5.9% of cases underwent renorrhaphy. It was found that 58.8% of cases had isolated renal trauma, and the overall mortality rate (2.9%) was due to related injuries. Conclusions The majority of blunt and penetrating renal trauma cases that are hemodynamically stable have a good outcome when treated with NOM. The presence of injury in other important organs both intra- and extra-abdominally aggravates the patient’s condition and affects the prognosis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Renal trauma: a 5-year retrospective review in single institution

et al. 2020

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“…There is a trend towards the increased use of AE in trauma in general and in renal injury in particular which will reduce the need for nephrectomy. 10 A survey of clinicians' practices revealed that AE is regularly used in low-grade renal injuries 11 ; however, the appropriateness has been questioned due to good outcomes with conservative management. 12 Its use in high-grade renal injuries is now well established although there are some studies that report a high failure rate with Grade V injuries.…”

Section: Centralisation Of Servicesmentioning

confidence: 99%

Management of renal injury in a UK major trauma centre

Torrance

Kwok

Mathews

et al. 2018

Trauma

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Introduction This study reviews the type, severity, management and follow-up of renal trauma presenting to a major trauma centre in the northwest of England in the four years following inception of the major trauma centre. Given the recent introduction of major trauma centres nationally, research is needed within every specialty to ensure that the centralisation of services benefits all patients affected by these changes. Methods Patients presenting to Aintree University Hospital with renal trauma between June 2012 and June 2016 were identified using the Trauma Audit and Research Network (TARN) database. The data gathered retrospectively for each patient included mechanism of injury, injury severity score, American Association for the Surgery of Trauma (AAST) grading, management of injury, and follow-up. Results Out of a total of 2595 trauma patients, 33 renal injuries were identified. The 31 patients who received imaging were classified according to AAST grading, with 8 Grade I (25.8%), 4 Grade II (12.9%), 8 Grade III (25.8%), 4 Grade IV (12.9%), and 7 Grade V (22.6%) injuries. Twenty-five out of the 30 surviving patients received conservative treatment, three patients received angioembolisation (AE), one patient received a laparotomy with renal suturing, and one patient required a nephrectomy. Of these 30 surviving patients, seven received urology follow-up in clinic (23%). Conclusion The findings appear to support the growing trend towards the conservative management of high-grade renal injuries, and provide further evidence for the value of AE in renal trauma. The success of AE in this study appears to support the centralisation of services in renal trauma; however, the low nephrectomy rate could be interpreted as suggestive of the opposite. The study revealed that improvements to follow-up are needed, and that further research should seek to inform the optimal radiological follow-up of high-grade renal injury.

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“…Trauma due to falling from a height or severe physical injury (blunt/non-penetrating trauma) has been reported as the cause of 80-95% of renal injury, which often occurs due to road accidents (12)(13)(14). The average severity of injury in patients with renal injury was significantly higher in comparison to people with injury to other organs (4).…”

Section: Introductionmentioning

confidence: 99%

Pattern and Severity of Traumatic Renal Injury: A Three-Year Study at Single Level One Trauma Center in Southern Iran

2023

ircmj

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Background: Renal trauma is among the most important trauma challenges. Better management of traumatic renal patients is necessary to improve the patients’ clinical outcome. Objectives: This study aimed to analyze the pattern, severity, mechanism of injury, and outcome in renal trauma. Methods: This cross-sectional study was conducted in the largest trauma center in southern Iran from March 2018 to June 2022. Adult patients with diagnosed renal trauma based on abbreviated injury scale guideline were included. Variables of age, gender, anatomy of injury, mechanism of injury, lenghth of hospitalization, level of blood pressure, severity of injury, and the outcome of patients have been collected. Results: In total, 4,416 traumatic patients were admitted to the Emergency Department of the Hospital during the study time, of which 46 cases had traumatic renal injury. The rate of renal injury in the level one trauma center in southern Iran was 0.96%, and the death rate in renal injury victims was 12(26.1%). Most of the injured with renal injury were men 39(84.8%). Blunt trauma was the dominant type of trauma in most victims with renal injury 34(73.9%). Thirty-seven percent (n=17) of traumatic renal injury victim was in mild level (grade 1 and 2), and 16(34.8%) in severe level (grade 4 and 5). Renal injury was mostly associated with thorax injury (n=46) as extra-abdominal organ injury, and liver injury (n=16) and spleen (n=15) as intra-abdominal organ injury. Conclusion: The results of the present study showed that the severity of injury in patients with renal injury is high, and it is usually associated by injury to other body organs. It is suggested that the traumatic patients should be immediately examined for renal injury in the resuscitation department due to the high mortality rate and severity of these patients.

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Management of High-grade Blunt Renal Trauma

Cited by 7 publications

References 16 publications

Renal trauma: a 5-year retrospective review in single institution

Renal trauma: a 5-year retrospective review in single institution

Management of renal injury in a UK major trauma centre

Pattern and Severity of Traumatic Renal Injury: A Three-Year Study at Single Level One Trauma Center in Southern Iran

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