High-Grade Renal Trauma Due to Blunt Injury: Do All Require Surgical Intervention?

Background: Renal trauma management has increasingly shifted toward non-operative treatment, particularly in hemodynamically stable patients. Advances in imaging, resuscitation, and monitoring have improved the outcomes of conservative management, even in high-grade injuries. Blunt trauma, most commonly from falls, is the leading cause, and renal injuries often occur within the context of polytrauma involving multiple organ systems. Management is primarily guided by hemodynamic stability, overall clinical condition, existing comorbidities, and the severity of injury as determined by the American Association for the Surgery of Trauma (AAST) grading system. This study aimed to describe the management strategies and clinical outcomes of patients with high-grade blunt renal trauma (AAST grades III-V), with particular emphasis on the use of conservative management in selected patients. Methods: This study is a retrospective analysis conducted in our department (Emergency Clinical County Hospital in Brasov, Romania) to identify the data of the patients admitted with high-grade blunt renal trauma from 1 January 2019 to 31 December 2025. Results: A total of 58 patients with blunt renal trauma (grade III or higher) were identified. According to the AAST classification, the most common injuries were grade III (35 patients), followed by grade IV (11 patients) and grade V (12 patients). The majority of cases (68.97%) were treated conservatively, and the overall mortality rate was 8.62%. Conclusions: This study highlights the importance of individualized management in renal trauma, supporting conservative treatment in hemodynamically stable patients. Hemodynamic stability, renal injury grade, and the extent of associated injuries should guide treatment decisions. Further research is needed to refine treatment protocols and assess long-term outcomes.