Login to Access Video or Poster Abstract: MP79-15
Sources of Funding: none

Introduction

Traumatic renal injuries are often managed conservatively without the need for operative exploration or embolization. Complications following non-operative management for renal trauma are low; however, post-traumatic hypertension (HTN) has been reported. We sought to determine if traumatic renal injuries, renal trauma grade, and/or computed tomography (CT) findings are predictive of developing long-term HTN.

Methods

We performed a retrospective review of a prospectively maintained renal trauma database at Zuckerberg San Francisco General Hospital from 1995-2015. Renal injuries were categorized using the American Association for the Surgery of Trauma grading system. Isolated non-renal genitourinary trauma patients were selected as controls. Patient charts were reviewed for a diagnosis of HTN on follow-up and/or initiation of anti-hypertensive medication(s). Renal CT scans were obtained for patients having renal trauma after July of 2004 and reviewed for injury characteristics. Patients with HTN prior to their trauma or lack of follow up were excluded.

Results

In total, 390 patients had renal injuries and 163 (42%) met our inclusion criteria. 142 controls were identified with traumatic non-renal, genitourinary injuries, and 60 (42%) met our inclusion criteria. The median age of patients at the time of their trauma was 31 years (interquartile range, IQR 23-43) with median follow up of 4.7 years (IQR 1.9-8.5). 23/163 (14%) of renal trauma patients were newly diagnosed with HTN on follow-up, compared to 2/60 (3%) in the control group (p=0.02). After adjusting for age, sex, race, history of nephrectomy, and follow-up time, the odds of developing HTN after a high grade renal trauma was 15.6 (95% confidence interval, CI 2.3-107.1) (Table 1). Patients with a mid-pole medial laceration with medial blood on CT had higher odds of developing HTN compared to patients without these characteristics (odds ratio, OR 5.36, 95% CI 1.3-22.6). Nephrectomy, or any renal procedures were not associated with developing HTN.

Conclusions

Increasing renal trauma grade is a risk factor for future development of HTN. CT findings at trauma presentation suggest mid-pole medial laceration with medial blood may be useful in stratifying patients who are at risk. Routine follow-up for the development of HTN is warranted following high grade renal trauma.

Funding

none