Retrospective analysis of renal injuries –instituitional experience

Introduction: Trauma is a major cause of morbidity and mortality. Decision making on management of renal injuries due to blunt abdominal trauma has changed over time. Conservative management of blunt renal trauma was first proposed and the resultant benefits shifted managing increasingly severe blunt renal trauma with a conservative approach. This has replaced the past tendency toward aggressive renorrhaphy and an absolute indication for surgical exploration is life threatening haemodynamic instability due to renal haemorrhage. Materials and methods: This study is a retrospective analysis of records of patients admitted over a period of 24 months. Computed tomography pictures were reviewed and the severity of renal injury was graded according to the American Association for the Surgery of Trauma (AAST) classification. Demographic data, mechanism and grade of renal trauma, management and outcome were analysed. Results: Present study includes 30 patients 15 of which had grade I and 6 had grade II injuries which were managed conservatively. 6 cases with grade III renal injuries underwent minimally invasive procedures with DJ stenting in three cases and DJ stenting with PCD in another three cases. 3 cases with grade IV and grade V renal injuries needed operative management, partial nephrectomy in two cases and nephrectomy in one case. Discussion: Decision making on management of blunt renal injuries has changed over time. More number of patients are managed conservatively but criteria for identifying who will be suitable for this approach remains controversial. Present study formed a basis for managing more cases conservatively. Conclusion: The support for conservative or expectant management has increased, even in the most seriously injured kidneys, replacing the past tendency toward aggressive renorrhaphy. Minimally invasive procedures like DJ stenting and percutaneous drainage play a major role in downgrading morbidity and mortality. More renal units can be saved by conservative management