Renal arterial injuries caused by blunt trauma

Ten patients from the Maine Medical Center with renal arterial injuries caused by blunt trauma are presented and analyzed along with 240 other case reports from the literature. Most patients were under 30 years of age and many were children. Injuries to the left side were more frequent; bilateral injuries occurred in 22 patients. Motor vehicle accidents were responsible for the majority of cases. Arterial thrombosis was the most common finding. Associated abdominal injuries were frequent, but the kidney itself was usually spared. Physical findings, urinalysis, and exploratory laparotomy were not reliable in the detection of arterial injury, but excretory urography and angiography were very accurate. Untreated unilateral injuries usually led to renal atrophy, but most did not cause hypertension; untreated bilateral injuries usually led to chronic renal failure or death. Few attempts at revascularization were successful. Excretory urography is recommended for all patients with blunt abdominal trauma; nonfunction should be investigated by angiography. Immediate bilateral repair is indicated in all cases of bilateral renal arterial injury, but repair of a unilateral injury is indicated only if it is promptly diagnosed in a young, stable patient.