Renal Trauma: Re-Evaluation of the Indications for Radiographic Assessment

Abstract

We studied prospectively 359 consecutive patients with blunt (306) or penetrating (53) renal trauma to refine the indications for radiographic evaluation. Various factors, including the degree of hematuria, presence of shock and associated injuries easily assessable at the time of initial evaluation, were correlated with the severity of renal injury to determine whether any combination of parameters will separate patients with renal contusions from those with significant renal injuries (minor and major lacerations, and vascular injuries). We identified 3 groups: group 1-85 patients with gross hematuria or microscopic hematuria and shock after blunt trauma (including all 23 with significant renal injuries), group 2-221 patients with microscopic hematuria but no shock after blunt trauma (all with renal contusions) and group 3-53 patients with penetrating trauma. No combination of parameters was able to predict a severe injury in group 3. Our data support radiographic evaluation in groups 1 and 3. However, because all patients in group 2 had renal contusions and experienced no complications from nonoperative management we believe that excretory urography, which is time-consuming and costly, can be avoided in patients with microscopic hematuria but no shock after blunt renal trauma.

Predictors of the Need for Nephrectomy After Renal Trauma

“…1 Advances in imaging and staging of renal trauma have led to increased renal preservation, attributed in part to increased nonoperative management and improvements in surgical renal salvage techniques. [2][3][4][5] It is well accepted that patients with low-grade renal injuries can be managed nonoperatively and will heal without surgical intervention. Although surgical exploration is accepted for patients with hemodynamic instability or peritonitis, controversy still exists regarding the management of hemodynamically stable patients with higher-grade renal injuries.…”

The Use of Ultrasonography as the Initial Diagnostic Exploration in Blunt Renal Trauma

“…The sonographic criteria used for diagnosis were ac cording to the description by Schmoller et al [19] and Jakse et al [13]: Renal contusion was defined according to Nicolaisen et al [16] as hematuria after renal trauma with a normal renal ultrasound. An intrarenal hematoma appears as a hypoechoic area circumscribed by normal renal parenchyma ( fig.…”

Tratamento Não Operatório Do Trauma De Vísceras Abdominais Parenquimatosas

“…25 Não estando a TC disponível para avaliação radiológica, a urografia excretora é um método aceitável, embora a sua acurácia para estadiamento de pacientes com trauma renal varie de 68 a 95%. 26 A utilização da ultrassonografia na avaliação do trauma renal permite a identificação de líquido livre na cavidade peritoneal, sem a preocupação de fazer o diagnóstico topográfico do órgão lesado. Pode fazer a avaliação do contorno e arquitetura do parênquima renal e definir a presença de hematoma ou outras lesões retroperitoneais.…”