Renal trauma

AAST Grading System for renal injuries

• Non-operative management
  • Grade I: Cortex contusion
  • Grade II: Cortex laceration
• Possible operative management
  • Grade III: Corticomedullary junction laceration
    • Grade IV: Collecting system laceration
• Operative management
  • Grade V: Shattered kidney, thrombosis of renal artery, avulsion of hilum

Treatment

• Absolute indications for renal exploration and intervention:
  • Life-threatening hemorrhage
  • Expanding, pulsatile, or non-contained retroperitoneal hematoma
  • Renal avulsion injury

Disposition

• Admit
  • All penetrating renal injuries
  • All gross hematuria
  • All grade II and higher injuries
• Discharge
  • Microscopic hematuria and no indication for imaging
  • Isolated renal trauma and contusion-type grade I injury
    • Instruct no heavy lifting; f/u in 1-2wk to document resolution of the hematuria
  • Grade I subcapsular hematoma can d/c'd w/ 24hr f/u

See Also

GU Trauma