Epidemiological pattern of renal injuries and their evaluation and management.

ABSTRACT

To determine the epidemiological pattern of renal injuries and to define appropriate methods for their evaluation and management. Material and Methods: We reviewed retrospectively the medical records of 65 patients who were admitted to Siriraj Hospital, between September 1996 and February 2000. Details of patients, mechanism of injury, chief complaint, hematuria, associated injuries, radiographic assessment, management and complications of renal injury were analysed. Results: The study group consisted of 54 men and 11 women with a mean age of 31 years. Blunt and penetrating trauma occurred in 55 (85%) and 10 (15%) patients, respectively. Hematuria was present in 62 patients (95%) and absent in 3 patients (5%). Associated organ injuries were present in 37 patients (57%) and mostly occurred in blunt trauma patients. Chest injuries were the most common cause of associated injuries. Associated abdominal injuries in 17 patients (26%) involved primarily the liver and spleen. In hemodynamically stable patients, preoperative staging was performed in 47 patients (72.3%) with an intravenous pyelogram (IVP). Of 55 patients with blunt renal injuries, 32 (58%) were managed nonoperatively and 23 (42%) underwent exploratory laparotomy. In patient with blunt trauma requiring laparotomy, 6 (26%) underwent renal exploration while the remaining 17 (74%) were treated with expec-tant management and 3 (17.6%) of them had renal complications. Nine out of 10 penetrating trauma patients required laparotomy with renal exploration, but none of them had renal complications. Conclusion: In the evaluation of renal injuries and the accurate staging of these, it is important to define the full extent of the injury in order to decide on the most appropriate management. This will avoid unnecessary surgery in patients with minor injuries and these with limited major injuries, and will avoid the risk of secondary surgery, renal loss and other complications in patients with extensive injuries treated by operation.