Traumatic Renal Injuries: the prevalence, management and outcome of renal vascular injury

Abstract Purpose To assess the prevalence, management and outcome of renal vascular injuries (RVI; active bleeding and contained vascular injuries) seen on admission CT. Also, we wanted to find out the prevalence and survival of patients with concomitant trauma to liver, spleen, and kidney seen on admission CT. Methods A retrospective, single-center, longitudinal cohort study with nine-year data (2013–2021) of all ≥ 15-year-old patients with severe abdominal trauma and an ICD code for renal injury (S37.0XX). The CT and angiographic examinations, their reports and images were reviewed for Injury Severity Score (ISS), New Injury severity Score (NISS), injury grade according to American Association for the Surgery of Trauma (AAST), active bleeding, arterial dissection, segmental infarct, pseudoaneurysm or AV-fistulae. Choice of treatment was assessed based on medical records and/or available angioembolization imaging and reports. Also, hospital length of stay and 30-day survival rate were reviewed. Results Out of 2805 patients with abdominal trauma (71% males), 243 patients (8.7%) had a renal injury. Of these, 182 underwent CT on admission (182/243; 74.9%). Median NISS was 27 (range 4–75) and 86.3% (157/182) had NISS > 15. The distribution of injury Grade according to AAST were as follows: G 1–12.1% (22/182); G 2–6.0% (11/182); G 3–53.3% (97/182); G 4–26.9% (49/182); G 5–1.6% (3/182). RVI was found in 56 patients (56/182; 30.8%). 19.6% (11/56) had a penetrating injury. 42 (42/56; 75%) patients had an active bleeding, including two with renal vein injury and two with bilateral bleeding. Eight patients had segmental infarct (8/56;14.3%), six patients had a pseudoaneurysm 6 (6/56; 10.7%), and three an arterial dissection (3/56; 5.4%). Ten (10/56; 17.9%) had angioembolization, and three (3/56; 5.4%) underwent a laparotomy. RVI patients were slightly older than those not having a RVI (43.6 y vs 37.8 y, p = 0.0409) and had more often a penetrating trauma (OR 2.836; 95% CI 1.127–7.136, p = 0.0416). In patients without or with RVI the mean hospital length of stay was 14.7 and 14.9 days (p = 0.9520), and 30-day survival 95.2% and 92.6% (p = 0.3165), respectively. Among patients for whom CT was available, fourteen (14/182; 7.7%) had an injury to liver, spleen and kidney, with no decreased 30-day survival compared to the rest of the study group (92.9% vs. 94.6%; p = 0.5237). Conclusion RVI was not uncommon in our study cohort, occurring in 30.8% of patients with renal injury who underwent CT on admission. Of these, 17.9% were treated with angioembolization. Patients with RVI were slightly older and were more likely to have a penetrating injury than patients without RVI. No statistically significant difference in hospital length of stay or in 30-day survival was found between patients without and with RVI.