Grades IV and V Renal Injury: How to Treat?

Kim, Doo Han; Jeon, Yun Su; Lee, Nam Kyu

Abstract

PURPOSE: Management of major renal injury caused by blunt trauma is still somewhat controversial. We investigated the characteristics of grades IV and V blunt renal injury patients who underwent conservative or operative treatment, and determined the feasibility of conservative treatment of such injury.
MATERIALS AND METHODS
We retrospectively reviewed the records of 25 patients who presented our hospital with grades IV or V blunt renal injury. The 10 patients treated conservatively were assigned to group 1, and the 15 patients treated surgically to group 2. Each group was compared with respect to initial evaluation, radiologic findings, associated injuries, duration of hospital and intensive care unit stay, transfusion requirements, complications and follow-up imaging.
RESULTS
We found that shock was the only characteristic sign of the surgical treatment group and that the degree of hematuria did not correlate with treatment options. Radiologic findings which differed significantly between the 2 groups were the proportion of devitalized segments to total renal parenchyma and the presence of ureteral opacification despite urinary extravasation. Patients in group 1 had lower transfusion requirements but longer hospitalization, both significantly. Follow-up imaging of group 1 patients revealed functioning renal parenchyma with resolution of retroperitoneal hematoma in 8 of the 10 cases (80%).
CONCLUSIONS
This study shows that conservative treatment of blunt grades IV and V renal injury should be considered for patients with hemodynamic stability, no significant associated intra-abdominal organ injuries, devitalized segments less than 25% of renal parenchyma and ureteral opacification despite urinary extravasation on radiologic finding.