Atualização da classificação e tratamento das lesões renais complexas

Abstract

The "Evidence-based Telemedicine -Trauma & Acute Care Surgery" (EBT-TACS) Journal Club performed a critical review of the literature and selected three up-to-date articles on the management of renal trauma. Our focus was on high-grade renal injuries, defined as AAST injury grades III-V. The first paper was the propose substratification of the AAST grade IV renal injury into grades IVa (Low Risk) and IVb (High Risk). The second paper was a revision of the current AAST renal injury grading system, expanding to include segmental vascular injuries and ureteral pelvic injuries and to establish a more rigorous definition of severe grade IV and V renal injuries. The last article analyses the diagnostic angiography and angioembolization in the acute management of renal trauma using a national data set in the USA. The EBT-TACS Journal Club elaborated conclusions and recommendations for the management of high-grade renal trauma.

Epidemiological analysis of polytrauma patients with kidney injuries in a university hospital

“…The variables analyzed were age, gender, mechanism of injury, degree of kidney damage, conduct individualized according to the degree of renal injury, overall conduct, associated injuries, complications and deaths. Lesions were classified according to the updated AAST scale 4 .…”

“…The hemodynamic findings in patients with abdominal solid organs trauma becomes the reference for the diagnosis and treatment algorithm, determining or excluding the selective non-operative treatment 4 .…”

Profile of renal trauma victims treated at a university hospital in Curitiba

“…One study observed CT use in 33.3% of cases, the other 66.6% requiring laparotomy for diagnosis 4 . Another found diagnosis by CT in 41% of cases 18 . We found no data in the literature comparing the use of diagnostic methods with the type of treatment employed.…”

“…In our study, there was no significant difference on who required surgery or were medically treated. Other authors seek to stratify the need or not of surgery through imaging methods, however, without consensus yet 18 .…”

“…None of the deaths occurred due to the renal trauma itself, being caused by other associated injuries. Other authors reported mortality rates ranging from 6.6% to 26%, also related to associated injuries 17,18 .…”