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Kidney trauma

Key sources
The following summarized guidelines for the evaluation and management of kidney trauma are prepared by our editorial team based on guidelines from the Eastern Association for the Surgery of Trauma (EAST 2023; 2019), the European Association of Urology (EAU 2022), the Society of Interventional Radiology (SIR 2020), the World Society of Emergency Surgery (WSES/AAST 2019), and the American Urological Association (AUA 2014).
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Guidelines

1.Diagnostic investigations

Clinical assessment
Assess hemodynamic stability upon admission of patients with suspected kidney trauma.
A
Record past renal surgery, and known preexisting renal abnormalities (ureteropelvic junction obstruction, solitary kidney, kidney stone disease).
A
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  • Urinalysis

  • Ultrasound

  • CT

  • Intravenous urography

2.Medical management

Nonoperative management
As per EAU 2022 guidelines:
Offer nonoperative management with close monitoring and repeat imaging as required in stable patients with blunt kidney trauma.
A
Offer nonoperative management in stable patients with isolated grade 1-4 stab or low-velocity gunshot wounds.
A

3.Therapeutic procedures

Angioembolization: as per EAST 2023 guidelines, insufficient evidence to recommend for or against angioembolization versus observation to decrease mortality, risk of surgical morbidity (delayed hemorrhage necessitating intervention and nephrectomy), and need for long-term RRT in hemodynamically stable adult patients with renal trauma and clinical or radiographic evidence of active bleeding.
I

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  • Endovascular balloon occlusion of the renal artery

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4.Surgical interventions

Indications for surgery
As per EAST 2023 guidelines:
Avoid performing renal exploration to decrease the incidence of mortality and nephrectomy in hemodynamically unstable adult patients with a stable zone II hematoma diagnosed intraoperatively.
D
Avoid performing total nephrectomy to decrease mortality, delayed hemorrhage necessitating intervention, angioembolization, and need for long-term RRT in hemodynamically unstable adult patients with an expanding zone II hematoma necessitating exploration.
D

5.Specific circumstances

Pediatric patients: obtain contrast-enhanced CT with delayed urographic phase as the gold standard in severely injured pediatric patients with suspected kidney or urinary tract injury.
A
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  • Patients with ureteral injury

  • Patients with bladder injury

  • Patients with urethral injury

6.Follow-up and surveillance

Serial imaging assessment: as per EAST 2023 guidelines, insufficient evidence to recommend for or against routine follow-up abdominal CT versus symptom-based abdominal CT to decrease the incidence of delayed hemorrhage necessitating intervention in hemodynamically stable adult patients with high-grade (AAST III-V) renal injuries managed nonoperatively.
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  • Long-term follow-up