Clinical Evaluation of Blunt Renal Trauma

Lee, Ho Seung; Kwon, Kyung Il; Yeum, Gyu Young

Abstract

PURPOSE: The evaluation of patients with suspected blunt renal trauma relies mainly on clinical assessment, urinalysis and imaging studies. For the evaluation of the effects of various factors in patients with blunt renal trauma, we performed this study. MATERIALS AND METHOD: We retrospectively reviewed the medical records of 103 patients who presented to our hospital with blunt renal trauma between 1991 and 1996. RESULTS: A total of 103 patients presented to our hospital with suspected blunt renal trauma. There were 72 male and 31 female between 8 and 82 years old (mean 35.7). Traffic accident was the most common cause of injury, accounting for 54.4%(56 cases). The remaining injuries were caused by falls in 30 cases (29.1%), assault in 15(14.6%) and sports-related trauma in 2(1.9%). Renal injuries were classified as established by the Organ Injury Scaling Committee of the American Association for the Surgery of Trauma in 1989. There were 61 cases(59.2%) grade I, 15(14.6%) grade II, 8(7.8%) grade III, II(10.6%) grade IV and 8(7.8%) grade V. Of the 103 patients 58 had microscopic hematuria and 40 had gross hematuria. We found that the degree of hematuria does not correlate with the severity of renal injury. 54 patients(52.4%) had a total of 69 associated injuries, including extremity fracture In 21, rib fracture in 14, pelvic fracture in 14, liver injury in 6, closed head injury in 6, spinal fracture in 3, bowel injury in 3 and spleen injury in 2. Surgical exploration was required in 15 patients(14.6%) for renal or associated injuries.
CONCLUSIONS
We should be managed blunt renal injuries with a consistent approach based on accurate injury definition from clinical, radiographic, and sometimes surgical staging. Accurate renal injury staging was essential to successful management of traumatized patients.