Successful Nonoperative Management of High-Grade Blunt Renal Injuries

Abstract

Current management of high-grade blunt renal trauma favors a nonoperative approach when possible. We performed a retrospective study of high grade blunt renal injuries at our level I trauma center to determine the indications and success of nonoperative management (NOM). 47 patients with blunt grade IV or V injuries were identified between October 2004 and December 2013. Immediate operative patients (IO) were compared to nonoperatively managed (NOM). Of the 47 patients, 3 (6.4%) were IO and 44 (95.6%) NOM. IO patients had a higher heart rate on admission, 133 versus 100 in NOM (P = 0.01). IO patients had a higher rate of injury to the renal vein or artery (100%) compared to NOM group (18%) (P = 0.01). NOM failed in 3 of 44 patients (6.8%). Two required nonemergent nephrectomy and one required emergent exploration resulting in nephrectomy. Six NOM patients had kidney-related complications (13.6%). The renal salvage rate for the entire cohort was 87.2% and 93.2% for NOM. Nonoperative management for hemodynamically stable patients with high-grade blunt renal trauma is safe with a low risk of complications. Management decisions should consider hemodynamic status and visualization of active renal bleeding as well as injury grade in determining operative management.

Incidence of urinary extravasation and rate of ureteral stenting after high-grade renal trauma in adults: a meta-analysis

“…In 5 studies ( 9 , 15 , 18 , 20 , 22 ), rates of urinary extravasation were only available for patients with grade IV injuries and in 6 studies ( 6 , 10 , 12 , 13 , 19 , 26 ) this rate was only available for grade IV–V injuries combined. The other studies included sufficient detail to calculate rates for different combinations of renal injury grades ( Table 1 ).…”

Cycling, and Male Sexual and Urinary Function: Results from a Large, Multinational, Cross-Sectional Study

“…13 The paradigm shift in management based on clinical status rather than severity of the injury may be attributed to improved radiographic techniques resulting in improved grading of the injury, advancements in resuscitation techniques, and availability of interventional radiology. 14,15 Advancements in angioembolization have likely aided in shifting practice patterns. Brewer et al reported success of angioembolization in patients with grade 5 renal trauma.…”

Does routine repeat imaging change management in high-grade renal trauma? Results from three level 1 trauma centers

“…Previous studies have shown that high-grade renal traumas can be managed conservatively [15]. Non-operative management of high-grade traumas results in a higher kidney salvage rate (87% vs 93%) with minimal complications as a consequence of non-operative management [15].…”

“…Previous studies have shown that high-grade renal traumas can be managed conservatively [15]. Non-operative management of high-grade traumas results in a higher kidney salvage rate (87% vs 93%) with minimal complications as a consequence of non-operative management [15]. The success of non-operative management with high-grade renal injury has also been demonstrated in the series presented by Buckley and McAninch in which 58% of isolated grade 4 renal injuries were managed conservatively with a renal salvage rate of 88%, with no non-operative case requiring delayed nephrectomy [16].…”