Etiology, classification, and management of renal trauma

Management of blunt renal trauma demands an aggressive effort to define the extent and severity of the renal injury with imaging studies. In general, a conservative approach to treatment is recommended that may include an early surgical exploration when the risk of late hemorrhage is great and the kidney or a portion of the kidney has obviously already been lost. To treat all patients with surgery or with expectant treatment is illogical. If expectant treatment is elected and the patient has a significant renal injury, every effort should be made to follow the patient adequately with ultrasound or CT scans in order to identify at the earliest opportunity an expanding hematoma and prevent needless nephrectomy and shock. Of most importance is to avoid inadequate studies that fail to define the source of injury and lead in the long run to inadequate surgical management. A tongue-in-cheek representation of such a scheme of treatment is illustrated in Figure 5.