Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Management of High-grade Blunt Renal Trauma

  • Lee, Min A (Department of Trauma Surgery, Gachon University Gil Medical Center) ;
  • Jang, Myung Jin (Department of Trauma Surgery, Gachon University Gil Medical Center) ;
  • Lee, Gil Jae (Department of Trauma Surgery, Gachon University Gil Medical Center)
  • Received : 2017.12.05
  • Accepted : 2017.12.17
  • Published : 2017.12.30
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Abstract

Purpose: Blunt injury accounts for 80-95% of renal injury trauma in the United States. The majority of blunt renal injuries are low grade and 80-85% of these injuries can be managed conservatively. However, there is a debate on the management of patients with high-grade renal injury. We reviewed our experience of renal trauma at our trauma center to assess management strategy for high-grade blunt renal injury. Methods: We reviewed blunt renal injury cases admitted at a single trauma center between August 2007 and December 2015. Computed tomography (CT) scan was used to diagnose renal injuries and high-grade (according to the American Association for the Surgery of Trauma [AAST] organ injury scale III-V) renal injury patients were included in the analysis. Results: During the eight-year study period, there were 62 AAST grade III-V patients. 5 cases underwent nephrectomy and 57 underwent non-operative management (NOM). There was no difference in outcome between the operative group and the NOM group. In the NOM group, 24 cases underwent angioembolization with a 91% success rate. The Incidence of urological complications correlated with increasing grade. Conclusions: Conservative management of high-grade blunt renal injury was considered preferable to operative management, with an increased renal salvage rate. However, high-grade injuries have higher complication rates, and therefore, close observation is recommended after conservative management.

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