Staging, evaluation, and nonoperative management of renal injuries

The kidney is the most commonly injured urologic organ and can sometimes be the most challenging to treat. Although most renal injuries may be treated successfully without operative intervention, it is important, and yet sometimes confusing, to delineate which cases should be managed with intervention and which may be observed. The common teaching that blunt renal injuries may be observed and penetrating injury must be explored may be true in most cases, but in select cases this dogma can be misleading and lead to poorer outcomes. The purpose of this article is to explain the important variables in the evaluation of renal trauma (clinical, radiologic, and sometimes surgical),how to stage renal trauma, and how to decide whether nonoperative or operative management is indicated.