[What treatment in kidney trauma? A critical evaluation treatment reports up to now based on a new classification]

The objective of treatment in renal injuries is to save the life of the traumatized patient, to maintain the function of the affected kidney(s) and to avoid later complications with their sequelae. It has not by any means been established what therapeutic measures (conservative or surgical) are appropriate to obtain the best results in certain traumas, e.g. penetrating injuries, 'moderately severe' parenchymal ruptures or obstructive vascular lesions, since 'conservative' does not automatically entail that there is no operation, and no operation does not automatically mean 'conservative'. According to my own analysis of treatment reports published up to now, inadequate classifications play a major role amongst the multivarious reasons for this. The results and complications are based on such heterogeneous criteria that valid comparisons are not possible. More differentiated measures with modern interventional and surgical techniques appropriate to each individual case can be used for a treatment enabling maximal preservation of the kidneys and which is as free of complications as possible. However, this presupposes a differentiated classification which takes all the relevant factors of renal trauma into consideration. Such a classification of the pathogenesis, location, extent and symptoms as prognostic factors is presented in a suggestion of my own in a gradual differentiation and a simple trauma formula. This enables therapies to be compared, and facilitates clinical decision-making, thereby improving the results of renal trauma treatment.