Nonoperative Management of Blunt Renal Trauma: A Prospective Study

Toutouzas, Konstantinos G.; Karaiskakis, Marios; Kaminski, Anna; Velmahos, George C.
December 2002
American Surgeon;Dec2002, Vol. 68 Issue 12, p1097
Academic Journal
Despite the abundance of literature on nonoperative management (NOM) of blunt trauma to the liver and spleen there is limited information on NOM of blunt renal injuries. In an effort to evaluate the role of NOM 37 consecutive unselected patients with renal injuries (grade 1, four; grade 2, 12; grade 3, 11; grade 4, six; and grade 5, four) were followed prospectively over 30 months (March 1999 to September 2001). Patients without peritonitis or hemodynamic instability were managed nonoperatively regardless of the appearance of the kidney on CT scan. Six (16%) patients were operated on immediately but only two (5.4%) for the kidney (grades 3 and 5 respectively). Of the remaining 31 patients 26 (84%) were managed successfully without an operation (grade 1 or 2, 12; grades 3-5, 14). Five patients were taken to the operating room after a period of observation (3, 3.5, 9, 36, and 44 hours respectively) but only three for the kidney (grades 4 and 5). The overall failure rate was 16 per cent (5 of 31); the rate of failure specifically related to the renal injury was 9.6 per cent (three of 31). Compared with the patients with successful NOM the five patients with failed NOM were more severely injured (Injury Severity Score ≥15 in 80% vs 27%, P = 0.04), required in the first 6 hours more fluids (4.17 ± 1.72 vs 1.87 ± 1.4 liters, P = 0.003) and blood transfusions (2.40 ± 2 vs 0.42 ± 1.17 units, P = 0.005), and more frequently had a positive trauma ultrasound (80% vs 11.5%, P = 0.005). We conclude that NOM is the prevailing method of treatment after blunt renal trauma. It is successful in the majority of patients without peritonitis or hemodynamic instability and should be considered regardless of the severity of renal injury. Predictors of failure may exist on the basis of injury severity, fluid and blood requirements, and abdominal ultrasonographic findings and need validation by a larger sample size.


Related Articles

  • Initiatives in Quality Care at the End of Life. Danko, Helen // Nephrology Nursing Journal;Apr2002, Vol. 29 Issue 2, p210 

    Talks about the need for educating nephrology professionals in palliative care. Position statement on end of life; Characteristics of palliative care; Suggested steps for the renal team.

  • Timing of renal replacement therapy initiation by AKIN classification system. Leite, Tacyano T.; Macedo, Etienne; Pereira, Samuel M.; Bandeira, Sandro R. C.; Pontes, Pedro H. S.; Garcia, André S.; Militão, Fernanda R.; Sobrinho, Irineu M. M.; Assunção, Livia M.; Libório, Alexandre B. // Critical Care;2013, Vol. 17 Issue 2, p1 

    Introduction: Previous studies using Acute Kidney Injury Network (AKIN)/RIFLE criteria to classify early initiation of renal replacement therapy (RRT) have defined it as the therapy started in less severe AKIN/RIFLE stages. Generally, these studies failed in demonstrating measurable benefits....

  • Estrogen-Mediated Renoprotection following Cardiac Arrest and Cardiopulmonary Resuscitation Is Robust to GPR30 Gene Deletion. Hutchens, Michael P.; Kosaka, Yasuharu; Zhang, Wenri; Fujiyoshi, Tetsuhiro; Murphy, Stephanie; Alkayed, Nabil; Anderson, Sharon // PLoS ONE;Jun2014, Vol. 9 Issue 6, p1 

    Introduction: Acute kidney injury is a serious,sexually dimorphic perioperative complication, primarily attributed to hypoperfusion. We previously found that estradiol is renoprotective after cardiac arrest and cardiopulmonary resuscitation in ovariectomized female mice. Additionally, we found...

  • Personal View. Gabriel, Roger // British Medical Journal (Clinical Research Edition);4/25/1987, Vol. 294 Issue 6579, p1094 

    Comments on the disasters occurring in a regional dialysis unit. Components of renal services; Decline in the bed accommodations in the renal wards of patients; Nursing staff of the wards.

  • Level of hydration and renal function in healthy humans. Anastasio, Pietro; Cirillo, Massimo; Spitali, Lucia; Frangiosa, Annamaria; Pollastro, Rosa Maria; De Santo, Natale G. // Kidney International;Aug2001, Vol. 60 Issue 2, p748 

    Level of hydration and renal function in healthy humans. Background. High hydration is commonly used in renal studies to improve the completeness of urine collection. The renal effects of hydration are not well defined. Methods. Renal function was studied under fasting conditions (baseline) and...

  • Critical care nephrology: The time has come. Ronco, Claudio; Bellomo, Rinaldo; Feriani, Mariano; La Greca, Giuseppe // Kidney International Supplement;May1998, Issue 66, pS-1 

    Focuses on the development of critical nephrology. Management strategies for patient with acute renal failure; Advancement on training, practice and research on patient care; Exploration of diagnostic measures and therapeutic strategies.

  • Diaverum Cares for 20,000 Patients.  // Biomedical Market Newsletter;1/28/2012, Vol. 21, p1 

    The article offers information on world's largest renal care providers called Diaverum which has passed the 20,000 patients milestone. It further informs about the company's market expansion which includes acquisition of renal clinics in Chile, Saudi Arabia and Romania. It mentions the training...

  • Is the inflammasome a potential therapeutic target in renal disease? Turner, Clare M.; Arulkumaran, Nishkantha; Singer, Mervyn; Unwin, Robert J.; Tam, Frederick W. K. // BMC Nephrology;2014, Vol. 15 Issue 1, p1 

    The inflammasome is a large, multiprotein complex that drives proinflammatory cytokine production in response to infection and tissue injury. Pattern recognition receptors that are either membrane bound or cytoplasmic trigger inflammasome assembly. These receptors sense danger signals including...

  • Monitoring of the peritoneal membrane. Struijk, Dirk G. // NDT Plus;Oct2008 Supplement 4, Vol. 1, piv29 

    Background. Indirect methods can be used to provide valuable information about peritoneal structure and function for the indirect analysis of peritoneal membrane.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics