RESUMO
Objective To evaluate renal angiography and segmental artery embolization in the management of non-iatrogenic renal trauma. Patients and Methods A retrospective study of 47 adult renal trauma patients treated in the period 1995 to 2002. Results The cause of injury was penetrating trauma in 36 (77) patients (33 stab and 3 gunshot injuries) and blunt trauma in 11 (23). Secondary hemorrhage occurred in 31 patients at a mean of 12.5 days after injury. Renal arteriography was performed in 41 patients. Abnormal findings in 34 included pseudoaneurysms in 20; arteriovenous fistulae in 10; contrast extravasation in 1; devascularized renal segments in 2 and renal artery occlusion in 1 case. Segmental renal artery embolization was successful in stopping renal hemorrhage in 24 of 28 cases (86) where it was attempted; while failure due to technical difficulty occurred in 4 patients (14). Major complications occurred in 2 cases (8) - one embolization of a coil to the external iliac artery and one perforation of a segmental renal artery. Later nephrectomy was performed in 2 patients who had hypertension with minimal function of the injured kidney on isotope renography. Of the 10 patients with abnormal findings on arteriography who did not undergo embolization; 6 required hemi-nephrectomy and 1 nephrectomy. Of the 6 patients who returned for follow-up renal imaging; 3 had 30differential function of the injured kidney. Conclusion Renal arteriography with the option of segmental artery embolization remains the first choice in the management of patients with severe hematuria after non-iatrogenic renal trauma