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Kidney trauma

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Updated 2024 EAU guidelines for the diagnosis and management of kidney trauma.

Guidelines

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 European Association of Urology (EAU 2024), the Eastern Association for the Surgery of Trauma (EAST 2023,2019), the Society of Interventional Radiology (SIR 2020), the World Society of Emergency Surgery (WSES/AAST 2019), and the American Urological Association (AUA ...
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Diagnostic investigations

Clinical assessment
As per EAU 2024 guidelines:
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

Medical management

Nonoperative management: as per EAU 2024 guidelines, offer nonoperative management with close monitoring and repeat imaging as required in stable patients with blunt kidney trauma.
A
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Therapeutic procedures

Angioembolization: as per EAU 2024 guidelines, perform selective angioembolization for active renal bleeding if there are no other indications for immediate surgical exploration.
A

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  • Endovascular balloon occlusion of the renal artery

  • REBOA

Surgical interventions

Indications for surgery
As per EAU 2024 guidelines:
Perform renal exploration in the presence of:
persistent hemodynamic instability
grade 5 vascular or penetrating injury
expanding or pulsatile peri-renal hematoma
A
Attempt renal reconstruction if the hemorrhage is controlled and there is sufficient viable renal parenchyma.
B

Specific circumstances

Pediatric patients: as per AAST/WSES 2019 guidelines, 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

Follow-up and surveillance

Serial imaging assessment: as per EAU 2024 guidelines, repeat imaging in high-grade and penetrating injuries and in cases of fever, worsening flank pain, or falling hematocrit.
A

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  • Long-term follow-up