Successful Nonoperative Management of High-Grade Blunt Renal Injuries

الملخص EN

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.