Penetrating renal trauma in a high-complexity Latin American centre: Management patterns and renal preservation, 2013-2025 - a retrospective cohort study.

Abstract

Background: Contemporary renal-trauma practice rests on blunt-predominant cohorts from high-income trauma systems, and penetrating renal injury remains under-described. We characterised the management and outcomes of penetrating renal trauma at a high-complexity Latin American centre, with blunt injury as internal comparator, and examined how practice changed over 13 years.

Methods: Retrospective cohort of 161 consecutive adults (≥18 years) treated between February 2013 and July 2025, classified by mechanism. Management, nephrectomy and in-hospital outcomes are reported descriptively as n (%) and median [IQR]. Testing was confined to three pre-specified questions: whether nephrectomy differed by mechanism; whether it differed by mechanism among patients taken to open surgery; and whether it changed over time. Two-sided exact p values were obtained by doubling the one-sided probability.

Results: Thirty-four injuries (21%) were penetrating (27 gunshot, 6 stab, 1 unspecified) and 126 (78%) blunt. Among penetrating injuries, 13 (38%) were managed non-operatively, 3 (9%) with angioembolisation and 18 (53%) with open surgery. Non-operative management was used up to AAST grade IV and failed in none, with no reintervention, nephrectomy or renal complication; angioembolisation preserved every treated kidney. Twelve of the 34 penetrating injuries (35%) ended in nephrectomy versus 5 of 126 blunt (4%; p < 0.001), and every nephrectomy in the cohort followed open surgery. Among the patients taken to open surgery, however, nephrectomy was equally frequent in the two groups (12 of 18 vs 5 of 9; p = 0.88), so renal loss tracked the decision to operate rather than intraoperative salvageability. High-grade (AAST IV-V) injury was similarly frequent by mechanism (41% vs 29%). Within penetrating injuries, open surgery fell from 15 of 24 in 2013-2019-3 of 10 in 2020-2025, and nephrectomy from 11 of 24-1 of 10, with a stable mechanism mix.

Conclusions: Selective non-operative management and angioembolisation preserved every kidney in which they were used, including after penetrating injury, and renal loss followed the decision to operate rather than the mechanism itself. These data support extending physiology-guided, kidney-preserving management to penetrating renal injury.