Renal injury management: no longer controversial

Abstract

Optimal management of renal injuries used to be a subject of controversy between the advocates of ‘early intervention’ and ‘expectant’ approach. Nowadays, most opinions have blended into a consensus for all but a small number and type of renal injuries. The purpose of this study was to investigate if the therapeutic approach in renal injuries is no longer controversial. We report the long-term results in 622 consecutive patients with renal injury, admitted to the University Hospital St Radboud in Nijmegen, The Netherlands, between 1972 and 1983. During this 11-year period a middle-course management was followed relative to indication and timing of operative intervention. This type of approach proved quite successful not only in reducing the nephrectomy rate but at the same time in lowering the incidence of early and late complications. It is concluded that choice and timing of therapy in renal injuries should depend on: 1. 1. Accurate diagnosis of the extent of the renal injury, 2. 2. Associated major injuries and 3. 3. Clinical condition of the patient. Such an individualized approach most benefits the patient.