To evaluate and compare the incidence and type of kidney-related complications among different modes of management for kidney injuries.
Trauma registry and medical record review study.
Level I trauma center in Los Angeles, California.
All patients with renal trauma injuries treated from January 1, 1993, through December 31, 2006.
Main Outcome Measures
Severity of kidney injury, method of renal treatment, and kidney-related complications.
During the study period, 889 patients had kidney injuries, 227 of whom (25.5%) had severe kidney injuries. In 568 patients (63.9%), the kidney was not explored; 173 patients (19.5%) underwent total nephrectomy, 53 (6.0%) underwent partial nephrectomy, and 95 (10.7%) underwent kidney repair. Of the 227 patients with severe kidney injuries, 89 (39.2%) received no exploration, 105 (46.3%) underwent total nephrectomy, 25 (11.0%) underwent partial nephrectomy, and 8 (3.5%) underwent nephrorrhaphy. The overall incidence of kidney-related complications excluding renal failure was 5.2%. The kidney repair group was significantly more likely to develop local kidney-related complications than the total nephrectomy, partial nephrectomy, and no kidney exploration groups, even though the nephrorrhaphy group had less severe kidney injuries. Patients with minor or moderate kidney injuries who underwent kidney exploration had more than twice the local complication rate than patients with no kidney exploration (7.1% vs 3.3%, P = .05).
Selective nonoperative management is safe for blunt and penetrating kidney injuries. Patients managed with nephrorrhaphy are at higher risk for local kidney-related complications than other therapeutic modalities. Patients with minor or moderate kidney injuries treated with exploration of the kidney are more likely to develop local complications than those treated without exploration.