[Blunt kidney trauma: a ten-year experience]

Abstract

Objective: The objective of this study is to assess the results of our therapeutic management of blunt kidney trauma in patients hospitalised over the last 10 years.

Materials and methods: From January 1993 to January 2003, 105 patients were hospitalised in our department for blunt kidney trauma. We retrospectively studied age, gender, injured side, mechanism of trauma (direct, indirect or deceleration), aetiology, presence of associated lesions (visceral, orthopaedic), and clinical and laboratory signs on admission (haematuria, blood pressure, haemoglobin and serum creatinine). The grade of the lesions was defined by radiological assessment, specifying the presence or absence of devascularized fragments and urine extravasation. All complications were noted and studied according to the initial therapeutic management and grade. Follow-up was clinical (BP and search for renal pain) and radiological (CT and/or DMSA scan).

Results: 105 cases of blunt trauma of the kidney were hospitalised between January 1993 and January 2003 in our department. The mean age of the patients was 28.7 years (range: 7-75 years). Trauma was classified into 5 grades on the basis of the radiological assessment according to the ASST (American Society of Surgery of Trauma): 51 (49%) cases of grade 1 (n = 26) and grade 2 (n = 25) trauma, and 54 (51%) cases of major grade 3 to 5 trauma: 17 grade 3 (16%), 28 grade 4 (27%) and 9 grade 5 (8%) were diagnosed. Among the cases of major trauma, 7 (13%) were operated urgently during the first 24 hours: 4 cases of grade 5 trauma with renal artery dissection and 3 cases of grade 4 trauma with immediate uncontrolled bleeding. The nephrectomy rate (partial and total), when major renal trauma (grade 3, 4 and 5) (n = 47) was managed conservatively was 23% (11 nephrectomies) with the loss of 9.5 renal units (20%); this rate was 57% for grade 4 trauma presenting urine extravasation and devascularized fragments (n = 14). Twelve patients (7 with grade 4 trauma and 5 with grade 3 trauma) were reviewed by DMSA scintigraphy with a mean follow-up of 63 months (range: 26-108 months). Traumatized kidneys presented a mean function of 41.8% (range: 26.4-50%).

Conclusion: Blunt kidney trauma is usually managed conservatively. The development of interventional radiology, endourological drainage techniques and medical intensive care helps to maintain this attitude by decreasing the need for surgery, even in the most severe trauma.