Published: 2020-10-21

A prospective observational study on the optimal management approach based on the clinical profile of renal trauma patients

Soumish Sengupta, Supriyo Basu, Kadambari Ghosh, Subhrajyoti Sengupta


Introduction: The kidney is the most commonly injured genitourinary organ following trauma. It can be a result of both blunt and penetrating trauma to the abdomen. Both conservative and surgical managements are employed as per the clinical profile of the patient.

Methods: This prospective observational study included all the patients with renal trauma who presented at the ER. Computed tomography (CT) was done for grading of renal trauma.

Results: A total of 60 patients were included in the study. Eighty percent (n=48) patients were managed conservatively. Twenty percent (n=12) patients underwent some form of surgical management. The mean (SD) hospital stay as 11.38 (6.94) days. Twenty-eight patients (46.67%) had right renal injury. Thirty-two patients (53.33%) had left renal involvement. There were no patients with bilateral renal injury. According to American association for the surgery of trauma (AAST), 11.66% patients (n=7) were categorised in grade I, 20% patients (n=12) to grade II, 33.33% patients (n=20) to grade III, 25% patients (n=15) to grade IV and 10% patients (n=6) to grade V. The most common associated injuries were rib fracture and visceral injury.

Conclusion: Much has changed since historical times with regards to renal trauma management. Data from various studies point towards a paradigm shift from surgical to conservative management as the standard of care irrespective of the grade and mode of renal trauma.


Trauma, Genitourinary organ, Penetrating, Computed tomography, Conservative

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Mingoli A, La Torre M, Migliori E, Cirillo B, Zambon M, Sapienza P, et al. Operative and nonoperative management for renal trauma: Comparison of outcomes. A systematic review and metaanalysis. Ther Clin Risk Manag. 2017;13:112738.

2. McGuire J, Bultitude MF, Davis P, Koukounaras J, Royce PL, Corcoran NM. Predictors of outcome for blunt high grade renal injury treated withconservative intent. J Urol. 2011;185:187-91.

3. Sugihara T, Yasunaga H, Horiguchi H, Nishimatsu H, Fukuhara H, Enomoto Y et al. Management trends, angioembolization performance and multi-organinjury indicators of renal trauma from Japanese administrative claims database. Int J Urol. 2012;19:559-63.

4. Yang CS, Chen IC, Wang CY, Liu CC, Shih HC, Huang MS. Predictive indicationsof operation and mortality following renal trauma. J Chin Med Assoc. 2012;75:214.

5. Shoobridge JJ, Bultitude MF, Koukounaras J, Martin KE, Royce PL, CorcoranNM. A 9 years experience of renal injury at an Australian level 1 trauma centre. BJU Int. 2013;112(2):53-60.

6. Moore EE, Shackford SR, Pachter HL, McAninch JW, Browner BD, Champion HR et al. Organ injury scaling: Spleen, liver, and kidney. J Trauma. 1989;29:16646.

7. Serafetinides E, Kitrey ND, Djakovic N, Kuehhas FE, Lumen N, Sharma DM et al. Review of the current management of upper urinary tract injuries by the EAU Trauma Guidelines Panel. Eur Urol. 2015;67:9306.

8. Santucci RA, Fisher MB. The literature increasingly supports expectant (conservative) management of renal trauma- A systematic review. J Trauma. 2005;59:493-503.

9. McCombie SP, Thyer I, Corcoran NM, Rowling C, Dyer J, Le Roux A et al. The conservative management of renal trauma: A literature review and practical clinical guideline from Australia and New Zealand. BJU Int. 2014;114(l1):13-21.

10. Bjurlin MA, Fantus RJ, Fantus RJ, Villines D. Comparison of non operativeand surgical management of renal trauma: Can we predict when non operative management fails? J Trauma Acute Care Surg. 2017;82:35661.

11.Voelzke BB, Leddy L. The epidemiology of renal trauma. Transl Androl Urol. 2014;3:1439.

12. Ząbkowski T, Skiba R, Saracyn M, Zieliński H. Analysis of renal trauma inadult patients: A 6 year own experiences of trauma center. Urol J. 2015;12:22769.

13. Wilden GM, Velmahos GC, Joseph DK, Jacobs L, Debusk MG, Adams CA et al. Successful nonoperative management of the most severe blunt renalinjuries: A multicenter study of the research consortium of New EnglandCenters for Trauma. JAMA Surg. 2013;148:92431.

14. McClung CD, Hotaling JM, Wang J, Wessells H, Voelzke BB. Contemporary trends in the immediate surgical management of renal trauma using a national database. J Trauma Acute Care Surg. 2013;75:6026.

15. Lanchon C, Fiard G, Arnoux V, Descotes JL, Rambeaud JJ, Terrier N et al. High grade blunt renal trauma: Predictors of surgery and long term outcomes of conservative management. A prospective single center study. J Urol. 2016;195:10611.

16. Narendra JB, Ratkal CS, Keshavamurthy R, Karthikeyan VS. Clinical profile of patients with renal trauma: A cross sectional observational study. Urol Sci. 2020;31:131-5.