High Grade Renal Injury can be Safely Managed Non-operatively

Abstract

Background: Among trauma patients, genitourinary injury occurs in 2%-5% of cases; with the kidney having the highest incidence of involvement. Grade IV/V renal injuries are typically associated with findings that necessitate intervention. However, non-operative management has been described even in severe cases. Our objective is to present our renal trauma experience in the blunt trauma patient population. Methods: We performed a retrospective chart review of all trauma patients from April 1, 2010-March 31, 2015. Those sustaining renal trauma were identified and patient demographics, injury parameters (grade of injury, injury severity score-ISS, cause and mechanism of injury), operative vs. non-operative management, outcomes (hospital length of stay-HLOS, ICU length of stay-ILOS) and discharge (mortality or disposition) were captured. Results: 8,054 patients were admitted to MDMC, with 112 meeting our inclusion criteria with 94 graded renal injuries. Renal operative management was noted in 6% of patients with ureteral stent placement (one Grade I), nephrorrhaphy (one Grade II), nephrectomy (two grade Vs, one grade IV) and renal vein repair (one grade IV). Nonoperative management of the renal injury occurred in 94% of cases. Conclusion: Low-grade injuries do well with non-operative management. However, Grade IV/V injuries can be challenging to manage. A significant concern is seen with the presence of major vascular or pelvicalyceal injury. Minimally invasive techniques by interventional radiology, vascular or urology surgery are ideal when possible. In conclusion, non-operative management for all grades of kidney injuries, despite the severity, is appropriate for the hemodynamically stable trauma patient.