Factors predicting of failure after conservative treatment in III–V grade renal trauma

Introduction and objectives: Surgical exploration of renal injury secondary to major trauma often leads to nephrectomy. The aim of this work was to identify the factors associated with the need for surgery in patients with III–V grade renal trauma who were initially managed conservatively. Materials and methods: We retrospectively reviewed data from patients with Grade III–V kidney injury between June 2005 and June 2015. Demographic, clinical and bio-radiological characteristics at admission and follow-up, as well as management and complications, were recorded. Patient data, including conservative treatment, was a success without recourse to nephrectomy, and those patients who needed surgery were analyzed. Results: Seventy three patients were included in this study. Grade III accounted for 45%, Grade IV: 49% and Grade V: 5%. The success rate for conservative treatment was 79%: 31 patients grade III (94%), 26 grade IV (72%) and no grade V patients. hypotension at admission (P = 0.04), hematoma size greater than 3.5 centimeters (P = 0.002), grade V (P = 0.003), anemia (P = 0.04), blood transfusion (P = 0.01) and worsening of lesions of the control CT lesions (P = 0.001), are the factors considered as predictive of failure of conservative treatment. Conclusion: Conservative management is the treatment of choice in III–V grade renal trauma, and the prognostic factors found in this study make it possible to better select patients. Level of evidence: 4.