6. Changing concepts in the diagnosis and treatment of closed renal injuries

Direct force is responsible for all closed kidney injuries except those involving the pedicle. Underlying parenchymal disease strongly predisposes the kidney to injury. Accurate diagnosis is crucial to rational treatment, and this is accomplished by infusion pyelography, angiography, retrograde pyelography and scanning. Treatment of kidney injuries has classically been conservatives, except when the clinical course or the nature of pre-existing diseases make an operation essential, but the current trend is towards more aggressive surgical treatment. This applies not only to pedicle injuries but also to major parenchymal trauma, and it is rendered feasible by precise diagnosis and improved surgical technique.