Renal Injury in the Polytrauma Patient

Approximately 8 % -10 % of blunt and penetrating abdominal injuries involve the kidneys. The incidence of associated injury in penetrating renal trauma ranges from 77% to 100%. Gunshot wounds are associated with organ injury more often than stab wounds (Saga-lowsky 1983; Carlton et al. 1968). The majority of patients with penetrating renal trauma have associated adjacent organ injuries that may complicate treatment. In the absence of an expanding hematoma with hemodynamic instability, associated multiorgan injuries do not increase the risk of nephrectomy (Kansas 2004).

Blunt and penetrating trauma equally contributed to combined renal and pancreatic injury, as reported by Rosen et al. (1994). Renal preservation was achieved in most patients and the complication rate of the series was 15%. A similar rate of complications (16%) was reported in patients with simultaneous colon and renal injury. In a report reviewing this combination of injuries over a period of 17 years, 58 % of patients underwent an exploration, with nephrectomies performed in 16% of explorations (Wessells and McA-ninch 1996).

Renal injuries seem to be rather rare in patients with blunt chest trauma. In a recent study with polytrauma patients, conservative management was safely attempted in polytrauma patients without increasing morbidity (Sartorelli et al. 2000). In polytrauma patients under going partial or total nephrectomy, there is no increased mortality or renal failure rate (Cassetal. 1987).

Multiorgan trauma patients who need multiple operations for associated intraabdominal injuries may undergo main artery embolization for severe renal injuries. In these cases, there is a high risk for sepsis, and postembolization nephrectomy is suggested (Sofocleo-us et al. 2005).

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