Ann Surg Treat Res.  2021 Jul;101(1):49-57. 10.4174/astr.2021.101.1.49.

Finding new indicators for operation and angiographic embolization in blunt renal injury patients: a single-center experience over 13 years

• Ha G
• Jang SW
• Shin IS
• Bang HJ
• An S
• Bae KS
• Jang JY
• Kim YW
• Kim K

• KMID: 2518333
• DOI: http://doi.org/10.4174/astr.2021.101.1.49

Abstract

Purpose
Traumatic kidney injury can be treated surgically or nonsurgically. Nonsurgical treatment options include angiography, embolization, and conservative treatment. We aimed to identify factors that help in making clinical decisions on treatment plans for patients with traumatic kidney injury caused by blunt trauma.
Methods
The study included 377 patients aged ≥18 years with traumatic kidney injury caused by blunt abdominal trauma admitted to the emergency room of Wonju Severance Christian Hospital between January 2008 and July 2020. Medical records, laboratory test results, and computed tomography results were retrospectively reviewed.
Results
Multivariable logistic analysis showed diastolic blood pressure at admission and disruption of Gerota's fascia were significantly associated with surgical treatment, and that perinephric hematoma rim distance was the only significant indicator favoring embolization. Receiver operating characteristic curve analysis showed that angiography and embolization should be considered when hematoma size exceeds 2.97 cm.
Conclusion
When a patient with traumatic kidney injury due to blunt trauma visits an emergency room, even when vital signs are stable, Gerota’s fascia should be checked by computed tomography prior to deciding on surgical treatment, and angiographic embolization should be considered if perinephric hematoma rim distance exceeds 2.97 cm.

Keyword

Abdominal injuries; Embolization; Gerota's fascia; Hematoma; Laparotomy