Renal Injury: 5-Year Experience and Literature Review

Abstract

Introduction: Appropriate management of renal trauma is controversial. The purpose of this study is to present our 5-year experience in renal trauma and review the literature. Materials and Methods: From 1999 to 2003, 28 patients were identified with renal injuries. 25 (89.3%) of the injuries were caused by blunt trauma, 2 (7.1%) by stab wounds, and 1 (3.6%) by gunshot wound. Methods for diagnosis included ultrasonography (US), computed tomography (CT), diagnostic peritoneal lavage (DPL), combinations of more than one technique or no one of them. The English-language literature about renal trauma was also identified using Medline, and additional cited works not detected in the initial search obtained. Results: 18 patients underwent immediate or during 24 h operation; while 5 nephrectomies were performed. 11 patients with grade I to III injuries were selected for nonoperative management of renal injuries. All complications were noted and studied according to the initial therapeutic management and grade. Follow-up was clinical and radiological. 3 postoperative deaths were observed. Conclusion: The goals of treatment of renal injuries include accurate staging and minimal complications. Surgery can be avoided in most cases of blunt renal injury but there is also a trend towards conservative management of penetrating trauma. Nephrectomy is associated with high-grade renal injuries, while minor renal injuries can safely be managed conservatively.

Management of High-grade Blunt Renal Trauma

“…Blunt injury accounts for 80 to 95% of renal injury trauma in the United States [2]. The majority of blunt renal injuries are low grade and 80 to 85% of these injuries can be managed conservatively [3].…”

Management of blunt renal trauma: an experience in 84 children

“…Moreover, presence of any abnormality on IVP usually requires CT or angiography to delineate the precise extent of injury [9]. In our study, the diagnosis rate of IVP was 82%.…”

“…One grade V injury child without hematuria managed with nonoperative detected urinary extravasation in ureteral running area by IVP 3 days after admission. So, nonoperative management must rely upon close monitoring and accurate staging [9], especially in high-grade injury patients without hematuria. From our 8-years experience, and supported by previous literature [18,19], we consider that nonoperative management is the most reasonable management method for hemodynamically stable children with blunt renal trauma.…”

Successful Conservative Treatment of Pediatric Renal Trauma and Inferior Vena Caval Thrombosis

“…Coagulation studies and other laboratory fi ndings were within normal limits. Computed tomography (CT) demonstrated hepatic and splenic lacerations, a retroperitoneal hematoma around the renal laceration (Grade 3) [1] and an IVCT without a urinoma ( • ▶ Fig. 1 ).…”