Role of Emergent Nephrectomy for Grade V Blunt Renal Injuries

03 August 2021: Articles

Unusual clinical course, Challenging differential diagnosis, Management of emergency care

John D. Ehrhardt ^A , Adel Elkbuli ^A* , Mark McKenney ^A , Dessy Boneva ^A

DOI: 10.12659/AJCR.932357

Am J Case Rep 2021; 22:e932357

Table 1. AAST Revised 2018 Renal Injury Grading Scale [2].

	Description	General management
I	Subcapsular hematoma/renal parenchymal contusion without laceration	Observation, no restrictions in absence of other injuries
II	Hematoma confined to Gerota’s fascia; laceration	Observation, bedrest, hemoglobin/hematocrit trending
III	Laceration >1 cm with no collecting duct injury; any urinary or vascular extravasation	Resuscitation, angioembolization, H&H trending, hemodynamic monitoring
IV	Laceration of collecting system; ureteropelvic transection; hemorrhage beyond Gerota’s fascia; segmental vessel bleeding/thrombosis	Resuscitation, angioembolization vs operative management; above measures; likely repeat CT imaging
V	Shattered kidney with destroyed parenchyma; main renal vessel avulsion; devascularized kidney with active bleeding	Similar to grade IV management, controversial and based on patient stability and response to resuscitation
AAST– American Association for the Surgery of Trauma; CT – computed tomography; H&H – hematocrit and hemoglobin. ^* Current evidence on follow-up imaging is evolving literature.