Rational guidelines in renal trauma assessment

Optimal management in renal trauma necessitates an adequate delineation of location and extent of the renal injury. However, as a result of the rapid rise in the costs of medical care, a complete and elaborate radiographic evaluation of all patients with suspected renal injury no longer seems justified. We reviewed our experience with 622 consecutive cases of renal injury to find the most economical diagnostic sequence with the clearest findings. An intravenous pyelography (IVP) still is the first and mostly the sole examination to do in patients with clinical or laboratory evidence of renal trauma. Microscopic hematuria alone is no longer an indication to perform urography. If indicated, an IVP should be performed as an emergency procedure in all cases and especially in the patient with multiple trauma. Children are more susceptible to renal trauma and require a higher index of suspicion. In the few patients with indeterminate findings on urography, renal angiography must be considered (especially when renal pedicle injury is suspected) or a computerized tomography (CT) scan (especially in the patient with multiple trauma). Ultrasound and CT examinations are not to be done on a routine basis in the initial assessment or the follow-up of renal trauma.