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Predictive factors for nephrectomy in renal trauma; assessment of a 6-point score

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

To evaluate predictive and associated risk factors for nephrectomy in renal trauma and assess a 6-point score for surgical decision-making.

Patients and methods

This multicenter, retrospective, and observational study assessed 247 subjects with blunt or penetrating kidney trauma. Kidney injuries were classified according to the American Association for the Surgery of Trauma (AAST) Injury Scoring Scale. Renal trauma was classified as “low-grade” (Grades I-III), Grade IV, and Grade V. Subjects were compared according to conservative treatment (CTrt.) or nephrectomy. Predictive factors were evaluated with a multiple regression model. A 6-point score was evaluated with a ROC analysis.

Results

Patients requiring nephrectomy had a lower mean arterial pressure MAP compared to CTrt, 64.71 mmHg (SD ± 10.26) and 73.86 (SD ± 12.42), respectively (p =  < 0.001). A response to IV solutions was observed in 90.2% of patients undergoing CTrt. (p =  < 0.001, OR = 0.211, 95%CI = 0.101–0.442). Blood lactate ≥ 4 mmol/L was associated with nephrectomy (p =  < 0.001). A hematoma ≥ 25 mm was observed in 41.5% of patients undergoing nephrectomy compared to 20.1% of CTrt. (p = 0.004, OR = 9.29, 95% CI = 1.37–5.58). A logistic regression analysis (p =  < 0.001) showed that blood lactate ≥ 4 mmol/L (p = 0.043), an inadequate response to IV solutions (p = 0.041) and renal trauma grade IV-V (p =  < 0.001), predicted nephrectomy. A 6-point score with a cut-off value ≥ 3 points showed 83% sensitivity and 87% specificity for nephrectomy with an AUC of 89.9% (p =  < 0.001).

Conclusions

An inadequate response to IV solutions, a lactate level ≥ 4 mmol/L, and grade IV-V renal trauma predict nephrectomy. A score ≥ 3 points showed a good performance in this population.

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Funding

There was no funding required for this study. The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Urology, Facultad de Medicina y Hospital Universitario “Dr. Jose Eleuterio Gonzalez”. Universidad Autonoma de Nuevo Leon, Av. Madero y Gonzalitos S/N, Mitras Centro, C.P. 64460, Monterrey, Mexico

    Rigoberto Pallares-Mendez, Daniel Eduardo Cervantes-Miranda, Carlos de la Cruz-de la Cruz, Adrian Gutierrez-Gonzalez, Mario Ochoa-Arvizo, Fred Montelongo-Rodriguez, Katherine Lyn Hernandez-Aranda & Jesús Arturo Cota-Agüero

  2. Department of Urology, Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Guadalajara, Mexico

    Evelyn Susana Castillo-Godinez

  3. Department of Urology, Hospital General “Dr. Manuel Gea González”, Mexico City, Mexico

    Marco Antonio Aguilar-Méndez

  4. Department of Urology, Hospital General de Zona No. 33. IMSS, Monterrey, Mexico

    Fernando Mendoza-Castillo

  5. Department of Legal Surgery, Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Guadalajara, Mexico

    Héctor Mata-Torres

Authors
  1. Rigoberto Pallares-Mendez
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  2. Daniel Eduardo Cervantes-Miranda
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  3. Evelyn Susana Castillo-Godinez
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  4. Carlos de la Cruz-de la Cruz
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  5. Marco Antonio Aguilar-Méndez
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  7. Fernando Mendoza-Castillo
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  8. Héctor Mata-Torres
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  11. Katherine Lyn Hernandez-Aranda
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  12. Jesús Arturo Cota-Agüero
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Corresponding author

Correspondence to Rigoberto Pallares-Mendez.

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Conflict of interest

The authors declare no conflict of interest.

Ethics approval

This retrospective study was approved by the Ethics Committee and registered as UR21-0002. In view of the retrospective nature of the study, all procedures being performed were part of the routine care.

Informed consent

All identifying details of the participants were codified and confidential. Due to the retrospective nature of the study, the Ethics Committee agreed to perform this study without informed consent.

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Pallares-Mendez, R., Cervantes-Miranda, D.E., Castillo-Godinez, E.S. et al. Predictive factors for nephrectomy in renal trauma; assessment of a 6-point score. Eur J Trauma Emerg Surg 49, 2241–2248 (2023). https://doi.org/10.1007/s00068-022-02006-w

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  • DOI: https://doi.org/10.1007/s00068-022-02006-w

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