03 August 2021>: Articles
Role of Emergent Nephrectomy for Grade V Blunt Renal Injuries
Unusual clinical course, Challenging differential diagnosis, Management of emergency care
John D. Ehrhardt A , Adel Elkbuli A* , Mark McKenney A , Dessy Boneva ADOI: 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. |