Introduction

AUA urotrauma guidelines for renal injury recommend conservative initial management for all stable patients, however, unstable patients with high-grade injury are often managed with nephrectomy. We hypothesized that there are clinical factors associated with need for nephrectomy.

Methods

From 2014 to 2016, data on high-grade renal trauma (AAST grade III-V) were gathered from 13 participating trauma centers. Demographics, injury characteristics, and trauma management were collected for patients with high-grade renal injury. Shock was defined as systolic blood pressure < 90 mmHg at the time of admission. Needing >10 packed red blood cell (PRBC) was defined as massive transfusion. Univariate logistic mixed effect models with clustering by facility were used to look at associations between proposed risk factors and nephrectomy._x000D_

Results

242 high-grade renal injuries were identified. The mean age and injury severity score (ISS) were 34.0 and 24.4. 34 (14%) nephrectomies were performed. 13/172 patients with blunt injury and 21/70 with penetrating trauma underwent nephrectomies (8% vs. 30%, P<0.001). The nephrectomy rate was 0/139 (0%), 14/69 (20%) and 20/34 (59%) for grades III, IV and V, respectively. Nephrectomies were performed during immediate laparotomy in 25 and were delayed in 9 at a median of 22 hours (range: 3-65 h). A general / trauma surgeon performed the nephrectomy in 26 (76%) of cases. In univariate analyses, renal AAST grade, ISS, presence of associated injuries, and penetrating injury were significantly associated with the need for nephrectomy. Also, clinical factors at admission such as higher heart rate, shock, higher lactate level, base deficit < -6, and massive transfusion needs were associated with higher odds of nephrectomy (Table-1)_x000D_

Conclusions

A considerable number of patients with grades IV and V renal injuries are still treated with nephrectomy. Clinical factors like presence of shock, higher heart rate and surrogates of metabolic acidosis were associated with need for nephrectomy for high grade renal injury._x000D_

Funding

This investigation was supported by the University of Utah Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 8UL1TR000105 (formerly UL1RR025764).