The kidney is the most frequently injured organ in genitourinary trauma, mostly in case of blunt trauma.
In the past decades, the management of these injuries has radically changed toward a more conservative approach, also thanks to a more precise diagnostic imaging in describing not only the presence of a lesion but also the negative prognostic factors, with an important increase in the use of interventional techniques.
Ultrasound (US) can show a renal injury and is useful to evaluate the presence of hemoperitoneum but is limited in the detection of extraperitoneal fluid. With the use of contrast-enhanced ultrasound (CEUS), the possibility of detecting renal parenchymal lesions and perirenal hematoma is greatly increased, but there is no opportunity to evaluate the urinary tract. Multidetector computed tomography (MDCT) is the modality of choice to evaluate renal injuries in polytrauma stable trauma patients.
Several classification systems have been raised, but the most used ones are the American Association for the Surgery of Trauma (AAST) injury scale, based on surgical findings, and the Federle classification, based on imaging findings. Based on these classification systems, the radiologist gives important information regarding the different injury types, leading to the correct choice of the therapeutical approach to kidney injury.
Kansas BT, Eddy MJ, Mydlo JH, Uzzo RG. Incidence and management of penetrating renal trauma in patients with multiorgan injury: extended experience at an inner city trauma center. J Urol. 2004;172:1355–60.CrossRefGoogle Scholar
Dugi DD III, Morey AF, Gupta A, et al. American Association for the Surgery of Trauma grade 4 renal injury substratification into grades 4a (low risk) and 4b (high risk). J Urol. 2010;183:592–7. doi:10.1016/j.juro.2009.10.015. Epub 16 Dec 2009.CrossRefPubMedGoogle Scholar
Lanchon C, Fiard G, Arnoux V, 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;195:106–11. doi:10.1016/j.juro.2015.07.100. Epub 6 Aug 2015.CrossRefPubMedGoogle Scholar
van der Wilden GM, Velmahos GC, Joseph DK, et al. Successful nonoperative management of the most severe blunt renal injuries: a multicenter study of the research consortium of New England Centers for Trauma. JAMA Surg. 2013;148:924–31. doi:10.1001/jamasurg.2013.2747.CrossRefPubMedGoogle Scholar
Armenakas NA, Duckett CP, McAninch JW. Indications for nonoperative management of renal stab wounds. J Urol. 1999;161:768–71.CrossRefGoogle Scholar
Poletti PA, Wintermark M, Schnyder P, Becker CD. Traumatic injuries: role of imaging in the management of the polytrauma victim (conservative expectation). Eur Radiol. 2002;12:969–78. doi:10.1007/s00330-002-1353-y. Epub 15 Mar 2002.CrossRefGoogle Scholar
Sessa B, Trinci M, Ianniello S, et al. Blunt abdominal trauma: role of contrast-enhanced ultrasound (CEUS) in the detection and staging of abdominal traumatic lesions compared to US and CE-MDCT. Radiol Med. 2015;120:180–9. doi:10.1007/s11547-014-0425-9. Epub 25 Jun 2014.CrossRefGoogle Scholar
Pinto F, Valentino M, Romanini L, Basilico R, Miele V. The role of CEUS in the assessment of haemodynamically stable patients with blunt abdominal trauma. Radiol Med. 2015;120:3–11. doi:10.1007/s11547-014-0455-3. Epub 21 Aug 2014.CrossRefGoogle Scholar
Sheth S, Casalino DD, Remer EM, et al. Appropriateness criteria: renal trauma. American College of Radiology; 2012.Google Scholar
McCombie SP, Thyer I, Corcoran NM, et al. The conservative management of renal trauma: a literature review and practical clinical guideline from Australia and New Zealand. BJU Int. 2014;114(Suppl 1):13–21. doi:10.1111/bju.12902.CrossRefPubMedGoogle Scholar
Mee SL, McAninch JW, Robinson AL, et al. Radiographic assessment of renal trauma: a 10 years prospective study of patient selection. J Urol. 1989;141:1095–8.CrossRefGoogle Scholar
Kurtz MP, Eswara JR, Vetter JM, et al. Blunt abdominal trauma from motor vehicle collisions from 2007 to 2011: renal injury probability and severity in children versus adults. J Urol. 2017;197:906–10. doi:10.1016/j.juro.2016.07.085. Epub 16 Dec 2016.CrossRefPubMedGoogle Scholar
Menichini G, Sessa B, Trinci M, Galluzzo M, Miele V. Accuracy of Contrast-Enhanced Ultrasound (CEUS) in the identification and characterization of traumatic solid organ lesions in children: a retrospective comparison with baseline-US and CE-MDCT. Radiol Med. 2015;120:989–1001. doi:10.1007/s11547-015-0535-z. Epub 31 Mar 2015.CrossRefPubMedPubMedCentralGoogle Scholar
Valentino M, Serra C, Pavlica P, Barozzi L. Contrast-enhanced ultrasound for blunt abdominal trauma. Semin Ultrasound CT MR. 2007;28:130–40.CrossRefGoogle Scholar
Scialpi M, Mazzei MA, Barberini F, et al. Traumi del surrene. In: Miele V, Scaglione M, Grassi R, Rotondo A, editors. Diagnostica per immagini del trauma maggiore. Milano: Elsevier Masson; 2010. p. 193–203.Google Scholar
Knudson MM, Maull KI. Nonoperative management of solid organ injuries. Past, present and future. Surg Clin North Am. 1999;79:1357–71.CrossRefGoogle Scholar
Brandes SB, McAninch JW. Reconstructive surgery for trauma of the upper urinary tract. Urol Clin North Am. 1999;26:183–99, x.CrossRefGoogle Scholar
Shanmuganathan K, Mirvis SE, Reaney SM. Pictorial review: CT appearances of contrast medium extravasations associated with injury sustained from blunt abdominal trauma. Clin Radiol. 1995;50:182–7.CrossRefGoogle Scholar
Cokkinos D, Antypa E, Stefanidis K, et al. Contrast-enhanced ultrasound for imaging blunt abdominal trauma—indications, description of the technique and imaging review. Ultraschall Med. 2012;33:60–7. doi:10.1055/s-0031-1273442. Epub 24 Jan 2012.CrossRefPubMedGoogle Scholar