Impact of treatment approaches on renal function in renal trauma patients.

Abstract

Introduction: Renal injuries account for 5% of all traumatic injuries, with blunt trauma being the most common cause (82-95%) [Meng, M.V., S.B. Brandes, and J.W. McAninch,, Renal trauma: indications and techniques for surgical exploration (17) 1999, Wessells, H., et al., Renal injury and operative management in the United States: results of a population-based study, 54(3) 2003]. Motor vehicle collisions (MVCs), pedestrian-vehicle accidents (PVAs), and falls often cause blunt renal injuries, frequently associated with intra-abdominal or thoracic trauma [Santucci, R., et al., Evaluation and management of renal injuries: consensus statement of the renal trauma subcommittee, 93(7) 2004]. Penetrating injuries, more common in urban areas, are typically severe and linked to firearm or sharp object incidents [Najibi, S., M. Tannast, and J.M. Latini, Civilian gunshot wounds to the genitourinary tract: incidence, anatomic distribution, associated injuries, and outcomes, 76(4) 2010]. Conservative management is generally recommended for grades 1-4 injuries [DiGiacomo, J.C., et al., The role of nephrectomy in the acutely injured 2001 136(9), Sujenthiran, A., et al., Is nonoperative management the best first-line option for high-grade renal trauma? A systematic review 2019 5(2)], and there is an increasing trend toward nonoperative management even for grade 5 injuries, though this remains a topic of debate [Keihani, S., et al., Contemporary management of high-grade renal trauma: results from the American Association for the Surgery of Trauma Genitourinary Trauma study 2018. 84(3), Moudouni, S., et al., Management of major blunt renal lacerations: is a nonoperative approach indicated? 2001 40(4)]. Our study aims to evaluate the impact of different treatment strategies on renal function outcomes in renal trauma patients.

Materials and methods: This multicenter, retrospective study reviewed data from 65 renal trauma patients, including clinical notes, radiology, and pathology reports. We analyzed demographics, trauma mechanisms, injury grades, associated injuries, transfusion needs, and long-term renal function assessed via DMSA scintigraphy. Angioembolization's impact on clinical stability, transfusion needs, and renal function preservation was specifically evaluated.

Results: Blunt trauma was the predominant mechanism (67.7% of cases). Angioembolization was performed in 10 patients, significantly reducing transfusion needs and preserving renal function (40% vs. 25% without; p = 0.009). Grade 5 injuries showed significant renal function decline, and conservative management increased the risk of severe complications. Urinoma developed in five cases, predominantly in high-grade injuries.

Conclusions: Angioembolization improves outcomes in severe renal trauma by stabilizing clinical conditions, reducing blood transfusion needs, and preserving renal function better than conservative approaches. Although surgical intervention remains a necessary option in select grade 5 cases, increasing evidence supports the role of nonoperative management in appropriately selected patients. Further research is needed to refine guidelines and incorporate more cases into decision-making protocols.