Renal Trauma Guidelines

Updated: Jan 01, 2019
  • Author: Dennis G Lusaya, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Guidelines Summary

The American Urological Association issued a guideline on urotrauma in 2014 and updated it in 2017. [9] Recommendations regarding renal trauma included the following:

  1. In stable blunt trauma patients with gross hematuria or microscopic hematuria and systolic blood pressure < 90 mm Hg, diagnostic imaging with intravenous (IV) contrast–enhanced computed tomography (CT) should be performed. (Standard; evidence strength: Grade B)
  2. Diagnostic imaging with IV contrast–enhanced CT should be performed in stable trauma patients whose mechanism of injury or physical exam findings raise concern for renal injury (eg, rapid deceleration; significant blow to the flank; rib fracture; significant flank ecchymosis; penetrating injury of the abdomen, flank, or lower chest)). (Recommendation; evidence strength: Grade C)

  3. IV contrast–enhanced abdominal/pelvic CT with immediate and delayed images should be performed when renal injury is suspected
  4. Noninvasive management strategies should be used in patients with renal injury who are hemodynamically stable. (Standard; evidence strength: Grade B)

  5. Hemodynamically unstable patients with no response or only transient response to resuscitation must undergo immediate intervention (surgery, or angioembolization in selected situations). (Standard; evidence strength: Grade B)
  6. Patients with renal parenchymal injury and urinary extravasation may initially be observed. (Clinical Principle)

  7. Follow-up CT imaging should be performed for renal trauma patients having either deep lacerations (American Association for the Surgery of Trauma [AAST] grade IV-V) or clinical signs of complications (eg, fever, worsening flank pain, ongoing blood loss, abdominal distention) (Recommendation; evidence strength: Grade C)
  8. Urinary drainage should be performed in patients with complications such as enlarging urinoma, fever, increasing pain, ileus, fistula or infection (Recommendation; evidence strength: Grade C); ureteral stenting should be used for drainage and may be augmented by percutaneous urinoma drain, percutaneous nephrostomy, or both. (Expert Opinion)