Features and outcomes of patients with grade IV renal injury

Shahrokh F. Shariat, Adam Jenkins, Claus Roehrborn, Jose A. Karam, Key H. Stage, Pierre I. Karakiewicz

Research output: Contribution to journalArticle

32 Scopus citations

Abstract

OBJECTIVE: To evaluate the clinical features and outcomes of patients who presented with grade IV renal trauma to our urban level I trauma hospital and to further refine the absolute indications for exploration and determine the outcomes of conservative management. PATIENTS AND METHODS: In all, 77 patients with grade IV traumatic renal injuries presented to our emergency department between October 1997 and October 2006. A prospective trauma database including these patients was analysed to determine the patterns of injury, operative outcomes and complications. RESULTS: A quarter of the patients had gunshot injuries, 9% had stab injuries, and 66% had blunt traumas. In all, 36% of patients required surgical exploration to treat associated non-urological injuries. There was no or microscopic haematuria in 29% of the patients. Of the 32 patients who underwent renal exploration, 63% (20/32) underwent renorrhaphy and 37% (12/32) underwent nephrectomy. In multivariate analyses, only gunshot injury, surgery for non-urological injury, and volume of blood transfused were significantly associated with the need for renal exploration (P = 0.015, P = 0.041, and P = 0.032, respectively). The renal complication rate was higher in patients managed conservatively vs those who underwent surgical exploration, but this was not statistically significantly different (28% vs 13%, P = 0.2). Hospital stay was longer after renal exploration than after conservative management at a median of 12 days vs 7 days (P = 0.01). CONCLUSIONS: While almost all patients with penetrating injury require renal exploration, only 20% of those with blunt trauma do. Patients with no renal injuries and/or haemodynamic instability are more likely to require exploration. Finally, the rate of complications was not statistically different according to management type (conservative vs renal exploration).

Original languageEnglish (US)
Pages (from-to)728-733
Number of pages6
JournalBJU international
Volume102
Issue number6
DOIs
StatePublished - Sep 1 2008

Keywords

  • Grade
  • Injury
  • Kidney
  • Nephrectomy
  • Renal exploration
  • Trauma

ASJC Scopus subject areas

  • Urology

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    Shariat, S. F., Jenkins, A., Roehrborn, C., Karam, J. A., Stage, K. H., & Karakiewicz, P. I. (2008). Features and outcomes of patients with grade IV renal injury. BJU international, 102(6), 728-733. https://doi.org/10.1111/j.1464-410X.2008.07638.x