What is the workup for Renal Trauma (RTA) type 4?

From the Guidelines

The workup for renal trauma, specifically Type 4 renal trauma, should prioritize non-invasive management strategies in hemodynamically stable patients, as recommended by the American Urological Association (AUA) guideline 1. The initial assessment of a patient with suspected renal trauma should include a thorough physical examination, vital sign monitoring, and laboratory tests such as complete blood count, blood urea nitrogen, creatinine, and urinalysis.

• Key findings in the urinalysis may include hematuria, which can be either microscopic or gross, and the presence of other abnormalities such as proteinuria or leukocyturia.
• Imaging studies, particularly contrast-enhanced computed tomography (CT) scan with delayed phases, are crucial for evaluating the extent of renal injury and guiding management decisions 1.
• The CT scan can help identify the grade of renal injury, which is classified according to the American Association for the Surgery of Trauma (AAST) organ injury scale.
• In hemodynamically stable patients with renal trauma, non-invasive management strategies, including bed rest, close monitoring of vital signs, and serial hematocrit measurements, should be employed whenever possible 1.
• Angiography and selective angioembolization may be considered in cases of active bleeding or vascular injuries, as these interventions can help control hemorrhage and preserve renal function 1.
• The management of renal trauma should be individualized based on the patient's clinical condition, the severity of the injury, and the presence of associated injuries or complications.
• A multidisciplinary approach, involving urologists, radiologists, and other specialists as needed, is essential for optimizing patient outcomes in cases of renal trauma 1.

From the Research

Workup for RTA Type 4 (Renal)

Imaging Studies

• Computed Tomography (CT) is the modality of choice in the evaluation of blunt renal injury 2
• Contrast-enhanced CT scans can help assess the extent of penetrating injuries in selected patients with limited posterior stab wounds 2
• Multiphasic contrast-enhanced CT has proven pivotal in the evaluation and management of traumatic kidney injury 3

Grading and Management

• The American Association for the Surgery of Trauma (AAST) grading system can be used to grade renal injuries and guide management and intervention 4
• Grade 4 renal injuries can be managed conservatively with close monitoring and CT scan protocols in hemodynamically stable patients 5, 6
• Endovascular angiography and embolization can be used to control bleeding in hemodynamically stable patients with renal trauma 4

Complications and Interventions

• Complications of renal embolization include short-term hypertension, long-term hypertension, acute kidney injury, and infection 4
• Urine leak can be treated conservatively with either a double J stent or a nephrostomy tube 5
• Arterial embolization can be performed in cases of continuous bleeding 5