230 HIGH GRADE RENAL INJURIES: APPLICATION OF PARKLAND HOSPITAL'S PREDICTORS OF INTERVENTION FOR RENAL BLEEDING TO A LARGE SERIES OF PATIENTS WITH BLUNT RENAL TRAUMA

Introduction This study reviews the type, severity, management and follow-up of renal trauma presenting to a major trauma centre in the northwest of England in the four years following inception of the major trauma centre. Given the recent introduction of major trauma centres nationally, research is needed within every specialty to ensure that the centralisation of services benefits all patients affected by these changes. Methods Patients presenting to Aintree University Hospital with renal trauma between June 2012 and June 2016 were identified using the Trauma Audit and Research Network (TARN) database. The data gathered retrospectively for each patient included mechanism of injury, injury severity score, American Association for the Surgery of Trauma (AAST) grading, management of injury, and follow-up. Results Out of a total of 2595 trauma patients, 33 renal injuries were identified. The 31 patients who received imaging were classified according to AAST grading, with 8 Grade I (25.8%), 4 Grade II (12.9%), 8 Grade III (25.8%), 4 Grade IV (12.9%), and 7 Grade V (22.6%) injuries. Twenty-five out of the 30 surviving patients received conservative treatment, three patients received angioembolisation (AE), one patient received a laparotomy with renal suturing, and one patient required a nephrectomy. Of these 30 surviving patients, seven received urology follow-up in clinic (23%). Conclusion The findings appear to support the growing trend towards the conservative management of high-grade renal injuries, and provide further evidence for the value of AE in renal trauma. The success of AE in this study appears to support the centralisation of services in renal trauma; however, the low nephrectomy rate could be interpreted as suggestive of the opposite. The study revealed that improvements to follow-up are needed, and that further research should seek to inform the optimal radiological follow-up of high-grade renal injury.

Download Full-text

The role of angioembolization in the management of blunt renal injuries: a systematic review

BMC Urology ◽

10.1186/s12894-021-00873-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Giovanni Liguori ◽

Giacomo Rebez ◽

Alessandro Larcher ◽

Michele Rizzo ◽

Tommaso Cai ◽

...

Keyword(s):

Operative Management ◽

Renal Trauma ◽

High Grade ◽

Contrast Extravasation ◽

Newcastle Ottawa Scale ◽

Grade Ii ◽

Non Operative Management ◽

Grade Iii ◽

Renal Injuries

Abstract Background Recently, renal angioembolization (RAE) has gained an important role in the non-operative management (NOM) of moderate to high-grade blunt renal injuries (BRI), but its use remains heterogeneous. The aim of this review is to examine the current literature on indications and outcomes of angioembolization in BRI. Methods We conducted a search of MEDLINE, EMBASE, SCOPUS and Web of Science Databases up to February 2021 in accordance with PRISMA guidelines for studies on BRI treated with RAE. The methodological quality of eligible studies and their risk of bias was assessed using the Newcastle–Ottawa scale Results A total of 16 articles that investigated angioembolization of blunt renal injury were included in the study. Overall, 412 patients were included: 8 presented with grade II renal trauma (2%), 97 with grade III renal trauma (23%); 225 with grade IV (55%); and 82 with grade V (20%). RAE was successful in 92% of grade III–IV (294/322) and 76% of grade V (63/82). Regarding haemodynamic status, success rate was achieved in 90% (312/346) of stable patients, but only in 63% (42/66) of unstable patients. The most common indication for RAE was active contrast extravasation in hemodynamic stable patients with grade III or IV BRI. Conclusions This is the first review assessing outcomes and indication of angioembolization in blunt renal injuries. The results suggest that outcomes are excellent in hemodynamic stable, moderate to high-grade renal trauma.

Download Full-text

Successful Nonoperative Management of High-Grade Blunt Renal Injuries

Advances in Urology ◽

10.1155/2016/3568076 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 8

Author(s):

Allison M. May ◽

Oussama Darwish ◽

Brian Dang ◽

John J. Monda ◽

Prajakta Adsul ◽

...

Keyword(s):

Nonoperative Management ◽

Operative Management ◽

Renal Trauma ◽

High Grade ◽

Current Management ◽

Entire Cohort ◽

Injury Grade ◽

Level I ◽

Salvage Rate ◽

Renal Injuries

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.

Download Full-text

MSCT IN NON-OPERATIVE MANAGEMENT OF HIGH GRADE BLUNT RENAL TRAUMA, A PROSPECTIVE STUDY

Zagazig University Medical Journal ◽

10.21608/zumj.2018.18295 ◽

2018 ◽

Vol 24 (6) ◽

pp. 526-543

Author(s):

Rania Almolla ◽

Hanan Hassan ◽

Amr Fawzi

Keyword(s):

Prospective Study ◽

Operative Management ◽

Renal Trauma ◽

High Grade ◽

A Prospective Study ◽

Non Operative Management

Download Full-text

Factors Predictive of Selective Angioembolization Failure for Moderate- to High-grade Renal Trauma: A French Multi-institutional Study

European Urology Focus ◽

10.1016/j.euf.2021.01.008 ◽

2021 ◽

Author(s):

Michael Baboudjian ◽

Bastien Gondran-Tellier ◽

Paul Panayotopoulos ◽

Marine Hutin ◽

Jonathan Olivier ◽

...

Keyword(s):

Renal Trauma ◽

High Grade

Download Full-text

Renal trauma

Journal of Clinical Urology ◽

10.1177/2051415817691642 ◽

2017 ◽

Vol 10 (4) ◽

pp. 379-390 ◽

Cited By ~ 1

Author(s):

Rajan Veeratterapillay ◽

Oliver Fuge ◽

Philip Haslam ◽

Chris Harding ◽

Andrew Thorpe

Keyword(s):

Minimally Invasive ◽

Renal Involvement ◽

Gunshot Wounds ◽

Subsequent Treatment ◽

Renal Trauma ◽

Haemodynamic Instability ◽

Cross Sectional ◽

Blunt Injuries ◽

Ureteric Stenting ◽

Renal Injuries

The kidney is the most commonly injured genitourinary organ, and renal involvement has been reported in 1–5% of all trauma cases. Two mechanisms of renal injury are described, namely blunt (direct blow to the kidney, rapid acceleration/deceleration or a combination) and penetrating (from stab or gunshot wounds), with blunt injuries being most common in the UK. It is important to keep an index of suspicion for renal trauma as given by the mechanism of the injury or in poly-trauma. Accurate assessment and resuscitation are vital in the initial management. Imaging with computed tomography is critical to the accurate grading of the injury and helps guide subsequent treatment. The approach to management of renal injuries has changed over time. During the past two decades, advances in cross-sectional imaging coupled with minimally invasive intervention strategies (like angiography, embolisation and ureteric stenting) for managing traumatic renal injuries have allowed increased renal preservation by reducing the need for major surgical intervention. Nowadays, the vast majority of blunt injuries (up to 95%) are managed conservatively with accumulated experience suggesting this is safe. However, there is still a role for open surgical exploration in patients with haemodynamic instability or those who fail initial conservative/minimally invasive management.

Download Full-text