Management of renal injury in the Department of Urology at the University Hospital in Pilsen

Authors: Daniela Kovářová 1;  Jana Hlaváčová 1;  Olga Dolejšová 1;  Petr Stránský 1;  Jan Bulka 2;  Milan Hora 1
Authors‘ workplace: Urologická klinika LF UK a FN, Plzeň 1;  Radiodiagnostické oddělení LF UK a FN, Plzeň 2
Published in: Ces Urol 2013; 17(3): 166-174
Category: Original article


We present a summary of our experiences and results with diagnostic algorithm and treatment of patients with renal injuries.

A total of 172 patients with renal injury were treated at the Department of Urology in Pilsen between January 2005 and December 2012. We performed a retrospective analysis based on mechanism of injury, diagnostic algorithm used, significance of haematuria and choice of treatment. Iatrogenic injuries were excluded.

Non-penetrating renal trauma occurred in 170 patients (98.8%) and stab wounds in two cases (1.2%). According to the AAST (American Association for the Surgery of Trauma) classification of traumatic injury, minor injuries were the most frequent, (Grade I and II) which occurred in 128 cases (74%). Major injuries (Grade III–V) occurred in 46 patients (26%). Various degree of haematuria occurred in 83.8% of cases. Conservative management was used in 142 patients (81.6%). Twelve patients (6.9%) underwent surgical exploration with reconstruction and 20 patients (11.5%) underwent a nephrectomy.

Non-penetrating, low-grade renal injury was found in the majority of cases. In some cases, hematuria was the only sign of renal trauma, although normal urinalysis did not completely excluded the injury. Computed tomography with intravenous contrast is the gold standard of imaging to evaluate patients with renal injury. In accordance with European standards, the conservative management aimed at preserving renal parenchyma was used preferentially.

Key words:
haematuria, renal injury, ultrasonography, computed tomography.


1. Djakovic N, Plas E, Martínez-Piñeiro L, et al. EAU Guidelines on Urological Trauma. Update 2009; March: 6–22.

2. Grill R, Záťura F, Urban M, Palascak P, Gomez-Orozco W. Poranění ledvin a možnosti zachování renálního parenchymu. Urol list 2005; 3(1): 14–21

3. Polyzois K, Liapis D, Aristas O, et al. The vulnerability of abnormal kidneys in blunt renal trauma and the necessary modifications in the treatment of these patients. European Urology Supplements 2003; 2(1): 3.

4. Schmidlin FR, Iselin CE, Naimi A, et al. The higher injury risk of abnormal kidneys in blunt renal trauma. Scand J Urol Nephrol 1998; 32(6): 388–392.

5. Mainer K. Poranění ledvin. Urologie pro praxi 2002; 3: 113–115.

6. Buchberger W, Penz T, Wicke K, Eberle J. Diagnosis and staging of blunt kidney trauma. A comparison of urinalysis, i.v. urography, sonography and computed tomography. Rofo 1993; 158(6): 507–512.

7. Santucci R, McAninch J. Diagnosis and management of renal trauma: past, present, and future. J Amer Coll Surg 2000; 191: 443–451.

8. Grill R, Mašková V, Ryantová V, Urban M. Poranění ledvin nižších stupňů (1. část): validita hematurie v diagnostice. Acta chirurgiae orthopaedicae et traumatologiae čechosl 2010; 77: 43–45.

9. Ku JH, Jeon YS, Kim ME, Lee NK, Park YH. Is there a role for magnetic resonance imaging in renal trauma? Int J Urol 2001; 8(6): 261–267.

10. Kawacziuk I. Urologie, první vydání. Praha: Galén 2009; 287–289.

11. Aragona F, Pepe P, Patanè D, et al. Management of severe blunt renal trauma in adult patients: a 10-year retrospective review from an emergency hospital. BJU Int 2012; 110(5): 744–748.

12. Baverstock R, Simons R, McLoughlin M. Severe blunt renal trauma: a 7-year retrospective review from a provincial trauma centre. Can J Urol 2001; 8(5): 1372–1376.

13. Serafetinides E, Ploumidis A, Kardakos I, et al. Conservative management versus organ preserving surgery in grade III renal ijuries: The long term follow-up. Eur Urol Suppl 2008; 7(3): 260.

14. Medica M, Cligiio M, Oneto F, Germinale F, Carmignani G. Conservative management of major blunt renal trauma: early and long term outcomes. European Urology Supplements 2003; 2(1): 3.

15. Ho YM, Schuetz M. Grade 4 renal injury: current trend of management and future directions. Chin J Traumatol 2011; 14(2): 120–122.

16. Bukur M, Inaba K, Barmparas G, et al. Routine follow-up imaging of kidney injuries may not be justified. J Trauma 2011; 70(5): 1229–1233.

17. Simmons JD, Haraway AN, Schmieg RE Jr, Duchesne JD. Blunt renal trauma and the predictors of failure of non-operative management. J Miss State Med Assoc 2010; 51(5): 131–133.

18. Van der Vlies CH, Olthof DC, Van Delden OM, et al. Management of blunt renal injury in a level 1 trauma centre in view of the European guidelines. Injury 2012; 43(11): 1816–1820.

19. Glentzes V, Martinis S, Tsanis A, et al. Angiography and embolization: A technique for nonoperative management of significant (grade II through IV) blunt renal trauma. Eur Urol Suppl 2005; 4(3): 235.

20. Chandrasekera S J, Wilkins J, Orley D, et al. Minimal access management of life threatening renal bleeding. European Urology Supplements 2005; 4(3): 236.

21. Lopera JE, Suri R, Kroma G, Gadani S, Dolmatch B. Traumatic occlusion and dissection of the main renal artery: endovascular treatment. J Vasc Intery Radiol 2011; 22(11): 1570–1574.

22. Haas CA, Reigle MD, Selzman AA, Elder JS, Spirnak JP. Use of ureteral stents in the management of major renal trauma with urinary extravasation: is there a role? J Endourol 1998; 12(6): 545–549.

23. Fiard G, Rambeaud JJ, Descotes JL, et al. Long-term renal function assessment with dimercapto-succinic acid scintigraphy after conservative treatment of major renal trauma. J Urol 2012; 187(4): 1306–1309.

24. Grill R, Báča V, Otčenášek M, Záťura F. Poranění ledvin nižších stupňů (2. část): Validita ultrasonografie v diagnostice. Acta chirurgiae orthopaedicae et traumatologiae čechosl 2010; 77: 140–142.

25. Lee JB, Chung JY, Ahn HS, et al. Treatment of renal injury: Changing patterns of recent 10 years-multicenter trial in Korea. Eur Urol Suppl 2010; 9(2): 97.

26. Shariat S, Dhami G, Stage K. Features and outcomes of pacienta with grade 4 renal injury. Eur Urol Suppl 2006; 5(2): 244.

27. Khan AR, Fatima N, Anwar K. Pattern and management of renal injuries at Pakistan Institute of Medical Sciences. J Coll Physicians Surg Pak 2010; 20(3): 194–197.

28. Watts RA, Hoffbrand BI. Hypertension following renal trauma. J Hum Hypertens 1987; 1(2): 65–71.

Paediatric urologist Nephrology Urology
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account