Successful Nonoperative Management of High-Grade Blunt Renal Injuries.

Allison M May,John J Monda,Sameer A Siddiqui,Prajakta Adsul,Brian Dang,Oussama Darwish,Johar Syed

doi:10.1155/2016/3568076

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.

Highlights

IntroductionUp to 10% of patients with abdominal trauma have renal trauma and greater than 90% of those are due to blunt injuries
Renal trauma accounts for a significant number of injuries in trauma patients
Three patients were treated with immediate operation resulting in nephrectomy

Summary

Introduction

Up to 10% of patients with abdominal trauma have renal trauma and greater than 90% of those are due to blunt injuries. High-grade injuries were managed operatively, which leads to nephrectomy in most cases. Multiple recent studies have investigated the risk factors for and outcome of operative versus NOM in grade IV injuries and the literature increasingly supports conservative management. Grade V injuries, are still treated operatively at many institutions and several studies have concluded that grade V injury is a predictor for operative management [4,5,6]. The most recent literature does include multiple studies suggesting that high-grade injuries, including grade V injuries, can be successfully managed conservatively [3, 7,8,9]

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Discussion

Conclusion