Classifying renal injuries helps to standardize different groups of patients, select appropriate therapy, and predict results. A total of 26 classifications for renal injuries have been presented in the literature in the past 50 years (Lent 1996), but the committee on organ injury scaling of the American Association for the Surgery of Trauma (AAST) has developed a renal-injury scaling system that is now widely used (Moore et al. 1989). Renal injuries are classified as Grade 1-5 (Table 15.4.1). Abdominal computed tomography (CT) or direct renal exploration is used to accomplish injury classification. Most recent clinical research and publications in the field of renal trauma have adopted this classification. In a retrospective review, the AAST scaling system was determined as the most important variable predicting the need for kidney repair or removal (Santucci et al. 2001) (Fig. 15.4.6).
Table 15.4.1. AAST renal injury grading scale (Moore 1989)
Grade Description of injury
1 Contusion or nonexpanding subcapsular hematoma No laceration
2 Nonexpanding perirenal hematoma
Cortical laceration < 1 cm deep without extravasation
3 Cortical laceration > 1 cm without urinary extravasation
4 Laceration: through corticomedullary junction into collecting system or
Vascular: segmental renal artery or vein injury with contained hematoma or partial vessel laceration or vessel thrombosis
5 Laceration: shattered kidney or
Vascular: renal pedicle or avulsion
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