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Updates in the Management of Complex Renal Trauma

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The High-risk Surgical Patient

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Abstract

The kidney benefits from a well-protected anatomical location, significant trauma is therefore usually required to cause injury with renal trauma occurring in isolation only 25% of the time. Renal trauma occurs secondary to blunt trauma; commonly caused by road traffic collisions, assaults, contact sports or falls or penetrating trauma usually caused by gunshot wounds or stabbings.

Initial investigation is as for all trauma, with particular attention to the mechanism of injury, history of pre-existing renal disease, signs of retroperitoneal haemorrhage and presence of haematuria. Delayed phase CT can be helpful in addition to a trauma series as it can assess the integrity of the collecting system and ureter. Renal injury is graded using the American Association for the Surgery of Trauma classification which helps predict the need for intervention and patient outcome based on the severity of the injury.

Haemodynamically stable patients can be managed conservatively with bedrest and close monitoring, with cross-sectional imaging repeated early in high-grade trauma. Should this approach fail minimally invasive approach techniques utilising angiography and embolisation of bleeding vessels can be employed, these can also be used in the treatment of iatrogenic renal injuries such as AV fistula or pseudoaneurysm. Haemodynamically unstable patients or those who fail initial management require surgical intervention in the form of a midline laparotomy with the exploration of the kidney and attempted repair, though this can often result in nephrectomy.

Complications following renal trauma include urinoma formation (which may require ureteric stenting), decreased renal function, delayed haemorrhage or hypertension.

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Authors and Affiliations

  1. Department of Urology, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

    Paul Gravestock, Arjun Nambiar, Rajan Veeratterapillay & Andrew Thorpe

  2. Department of Radiology, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

    Phil Haslam

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  1. Paul Gravestock
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  2. Arjun Nambiar
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  3. Rajan Veeratterapillay
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Correspondence to Andrew Thorpe .

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Editors and Affiliations

  1. Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Paolo Aseni

  2. Divisione di Cardiochirurgia, IRCCS Fondazione Policlinico San Matteo, Pavia, Pavia, Italy

    Antonino Massimiliano Grande

  3. Div. of Emerg. Surg., Abdominal Center, Helsinki University Hospital Meilahti, Helsinki, Finland

    Ari Leppäniemi

  4. Department of Pathophysiology and Transplantation, General Surgery and Trauma Team, University of Milano, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Osvaldo Chiara

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Gravestock, P., Nambiar, A., Veeratterapillay, R., Haslam, P., Thorpe, A. (2023). Updates in the Management of Complex Renal Trauma. In: Aseni, P., Grande, A.M., Leppäniemi, A., Chiara, O. (eds) The High-risk Surgical Patient. Springer, Cham. https://doi.org/10.1007/978-3-031-17273-1_66

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