How is renal trauma graded?

Updated: Mar 27, 2021
  • Author: Dennis G Lusaya, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

To determine the appropriate management for a renal injury, the renal injury first needs to be accurately staged. The American Association for the Surgery of Trauma (AAST) has defined renal trauma in five grades, as shown in the table below. [29, 30, 31, 32]

Table. American Association for Surgery of Trauma Renal Injury Scale (Open Table in a new window)

Grade

Type

Description

I

Contusion

Microscopic or gross hematuria, urologic studies normal

Hematoma

Subcapsular, non-expanding without parenchymal laceration

II

Hematoma

Non-expanding perirenal hematoma confined to renal retroperitoneum

Laceration

< 1.0 cm parenchymal depth of renal cortex

III

Laceration

> 1.0 cm parenchymal depth of renal cortex without collecting system rupture or urinary extravasation

IV

Laceration

Parenchymal laceration extending through renal cortex, medull, and collecting system

Vascular

Main renal artery or vein injury with contained hemorrhage

V

Laceration

Completely shattered kidney

Vascular

Avulsion of renal hilum that devascularizes kidney


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