Lanchon et al evaluated management of patients with blunt renal trauma. They felt that nonoperative management should be the initial management for most cases of blunt renal trauma. The authors are from Grenoble University Hospital in France.
Patient selection: Grade IV or V blunt renal trauma
Outcomes: occurrence of open surgery. A grade V injury to a kidney was associated with 0% long-term function.
Nonoperative management can include:
(1) ureteral stent
(2) angioembolization
(3) endoscopic procedure (ureteroscopic)
Predictors of open surgery:
(1) hemodynamic instability (which was often associated with surgical visceral lesions)
(2) Grade V blunt trauma
Most patients in thieir series underwent initial nonoperative management. This was sufficient in most cases of Grade IV trauma. It also allowed the patient to be stabilized prior to surgery if it was necessary.
Patients went to surgery after initial conservative management for:
(1) continued hemorrhage
(2) persistent fever
(3) urinary extravasation
(4) compartment syndrome
(5) persistent pain
(6) shattered kidney
A kidney with Grade IV trauma was at risk for long-term decline in renal function if greater than 25% of the renal parenchyma was devascularized.
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