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Study highlights role of conservative management for penetrating renal trauma
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Research from a single institution and published in The Canadian Journal of Urology underscores nonoperative management as a feasible option for patients with penetrating renal trauma.
“Traditionally, patients with penetrating trauma underwent surgery to explore the kidney and repair it,” Sameer A. Siddiqui, MD, study researcher and director of urologic surgery at Saint Louis University, said in a press release. “It was common that kidneys had to be removed if the patient underwent surgery. The role of a nonsurgical approach is emerging as an option and we’re seeing that even many high-grade injuries can be managed without surgery, limiting the risks associated with surgery. The main takeaway is that we can safely watch patients with penetrating trauma to the kidney frequently and the patient can avoid the risks of surgery and not risk losing their kidney.”
Researchers reviewed the records of 121 patients with penetrating renal trauma between 2009 and 2014 to compare nonoperative management of these injuries with operative approaches. Researchers found 90% of patients with penetrating renal trauma were men, with a mean age of 30 years. Gunshot injury caused 87% of trauma. Overall, 18% of patients required nephrectomy.
According to the authors, the mean injury severity score for the entire cohort was 20 and high-grade renal injuries were seen in 34% of patients. Among patients with high-grade renal injuries, 34% underwent a nephrectomy and 66% of patients were managed conservatively to salvage renal units. CT grade of renal injury was the only predictor of nephrectomy following penetrating renal trauma, according to the study.
“Renal failure had a higher association with nephrectomy compared to any other therapeutic interventions,” the researchers wrote. “Interestingly, no difference in complication outcomes were noted between non-exploration vs. exploration of kidneys after severe renal trauma, however complication rates were better for non-exploration group with minor or moderate renal trauma.”
Disclosures: Healio Nephrology was unable to report any relevant financial disclosures at the time of publication.
Reference:
www.slu.edu/medicine/index.php
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