Evaluating Follow-Up and Renal Function Outcomes in Trauma Patients With Urologic Injuries: Insights From a Level I...

To assess the significance of renal dysfunction in the setting of American Association for the Surgery of Trauma (AAST) renal injuries and follow-up patterns among renal trauma (RT) patients.

We retrospectively reviewed a prospectively maintained database of patients admitted with traumatic renal injuries to a level I trauma center from 2020 to 2023. AAST grades I-III were defined as low-grade renal trauma (LGRT), and AAST grades IV-V were defined as high-grade renal trauma (HGRT). Primary outcomes were creatinine on admission and follow-up. Secondary outcomes included pre-/post-injury creatinine and AAST grade.

Among 285 patients identified with AAST renal injuries who survived hospitalization, 97 (34.0%) had an elevated admission creatinine (median 1.44 [IQR 1.30-1.76] mg/dl). Over two-thirds of patients with elevated creatinine had LGRT. Seventy-seven (79.4%) of 97 patients with elevated creatinine had a repeat measure obtained a median of 15.5 (IQR 6.75-32.25) months post-injury. Of these, 16 (20.8%) demonstrated persistent creatinine elevation (median 1.42 [IQR 1.33-1.61] mg/dL; p < 0.001), with > 30% having LGRT. Admission and post-injury creatinine remained significantly elevated compared to pre-injury levels in both LGRT and high-grade RT (grades IV-V) (p < 0.01). No patients had creatinine intentionally assessed by any specialty service after hospitalization.

One in five patients with elevated creatinine in the setting of RT may be at risk for chronic kidney disease. Follow-up should be considered for any patient with elevated creatinine, regardless of renal injury grade.