Postoperative Care and Followup

Patients who are successfully treated conservatively carry some risk of presenting with complications. This risk correlates with increasing grade. Repeat imaging 2-4 days after trauma minimizes the risk of missed complications, especially in Grade 3-5 blunt renal injuries (Blankenship et al. 2001). However, the utility of frequent CT scanning after injury has never been satis-factorilyproven. CT scans should always be performed on patients with fever, unexplained decreasing hematocrit, or significant flank pain.

Nuclear renal scans are useful for documenting and tracking functional recovery in patients following renal reconstruction before discharge from hospital (Wessells et al. 1997b). To detect many of the delayed complications, an excretory urogram is recommended within 3 months of major renal injury, although benefit to the patient has not yet been proven in the literature. Follow-up should involve physical examination, urinalysis, individualized radiological investigation, serial blood pressure measurement, and serum determination of renal function (McAninch et al. 1991; Moudouni et al. 2001a). It is recommended that follow-up examinations should continue until healing is documented and laboratory findings stabilized, although checking for latent renovascular hypertension may need to continue for years.

Literature is generally inadequate on the subject of long-term consequences of trauma on renal tissue. It appears that on histopathological evaluation, renal tissue may appear dystrophic following some cases of conservative management of minor renal injuries (Pru-thi et al. 1998).

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