Nephrectomy versus renal repair after trauma to the kidney: preserve or sacrifice?

The objective of this retrospective study (1992-2003) is to evaluate the effect of nephrectomy in postoperative renal dysfunction. NEPHRECTOMY patients had their kidneys removed and REPAIR patients repaired or only partially resected. All patients were matched 1:1 with controls according to age, Injury Severity Score, Abdominal Abbreviated Injury Score, and mechanism of injury. Outcomes measured were renal dysfunction (serum creatinine > 2 mg/dl for > 2 consecutive days), renal dialysis, length of hospital stay, and mortality. Of 214 patients, 149 were NEPHRECTOMY and 65 REPAIR. Compared to their controls, NEPHRECTOMY and REPAIR patients had a higher rate of renal dysfunction. However, the rate was not different between NEPHRECTOMY and REPAIR. Multivariate analysis found no independent effect of the choice of operation in the development of renal dysfunction. No differences were found in the remaining outcomes measured. We conclude that although renal injury is associated with postoperative renal dysfunction, the type of operation is not. Nephrectomy can be offered when necessary without concerns about increasing the likelihood of postoperative renal failure.