Grade V Renal Injury – Short and Long Term Outcome

Rajendra B Nerli*, Vikas Sharma, Basavaraj M Kajagar, Neeraj S Dixit and Nitin D Pingale

Introduction: Over the last few decades, non- operative management (NOM) has become increasingly popular, especially for low-grade (I-III) blunt renal injuries.The published evidence is unclear about the  role of NOM for higher grades (IV and V). We took up this study to report our short and long-term outcomes following initial nonoperative management in patients sustaining a grade 5 renal injury secondary to blunt trauma.

Materials and Methods: The charts of all patients who presented to our institution with blunt renal trauma between Jan 2000 and Dec 2014 and had grade V renal injury were identifed and analyzed.

Results: 114 patients were identified, with grade V renal injury following blunt trauma (BRI). 9/114 patients (7.89%) died following resuscitation in the casualty and emergency services, 4 (3.50%) of whom had  deaths that were related to the kidney injury. 36 (34.28%) underwent early surgical exploration (13 – 42 hours) for various indications and nephrectomy was performed in 21 (58.33%). Eight patients who were  on non-operative management needed delayed surgical exploration of which two patients (25%)  presenting with massive secondary bleeding needed nephrectomy for control of the bleeding.

Conclusions: 41.9% of patients with grade V renal injury needed surgical exploration of which 34.28%  underwent early, whereas 7.61% underwent delayed exploration. 58.33% of patients undergoing early exploration and 25% of patients undergoing delayed exploration ended up with nephrectomy. Non operative management would be safe in the majority of patients with grade V renal injuries secondary to blunt trauma.

Keywords: Renal trauma; Blunt trauma; Shattered kidney; Non-operative management

Published on: Mar 13, 2017 Pages: 20-25

Full Text PDF Full Text HTML DOI: 10.17352/ojt.000005
CrossMark Publons Harvard Library HOLLIS Search IT Semantic Scholar Get Citation Base Search Scilit OAI-PMH ResearchGate Academic Microsoft GrowKudos Universite de Paris UW Libraries SJSU King Library SJSU King Library NUS Library McGill DET KGL BIBLiOTEK JCU Discovery Universidad De Lima WorldCat VU on WorldCat