Grade V Renal Injury – Short and Long Term Outcome

Abstract

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 non-operative management in patients sustaining a grade V renal injury secondary to blunt trauma. Material(s) and Method(s): 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 identified and analyzed. Result(s): 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. Conclusion(s): 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.