Introduction: Current AUA Urotrauma guidelines recommend immediate intervention for hemodynamically unstable renal trauma patients. While selective angioembolization is often favored over surgery as it offers the potential advantage of a nephron sparing approach, the impact on overall renal function and need for hemodialysis is not well established. We hypothesized that selective angioembolization for high-grade renal injuries does not increase the need for hemodialysis during the index admission.
Methods: 611 patients with high-grade renal trauma, defined as American Association for the Surgery of Trauma Grade (AAST) III-V injuries, from 2005 through 2020 were identified from our institutional trauma registry. Of these patients, we identified all patients who had renal failure that required hemodialysis (HD) during their index admission. Univariate and multivariate analyses were performed to identify associations of arrival condition (responsive vs not), hypotension on arrival, ASST grade, age, injury severity score (ISS), presence of bilateral renal injury, urinary extravasation, perinephric fluid collection, or selective renal embolization with the need of HD.
Results: Four hundred and eight patients had AAST III injuries, 150 had AAST IV and 53 had AAST V. Nineteen (3.1%) of the 611 patients had renal failure requiring HD during their trauma admission. Of those 19 patients, 4 (21.1%) underwent an angioembolization. There were 17 embolized in the non-HD group. Variables associated with need for HD were arrival condition (p=0.005), hypotension on admission (p=0.035), AAST injury grade (p=0.0007), age (p=0.004), ISS (p=0.0001) and angioembolization (p= <0.0001). On multivariate analysis adjusting for ISS and arrival hypotension undergoing angioembolization resulted in an increased odds of requiring HD (OR 10.0, 95% CI 2.36-36.0).
Conclusions: The current practice in high-grade renal trauma favors selective embolization as first line therapy for renal hemorrhage in unstable patients. Our data suggests that when adjusted for overall injury severity and hypotension, selective embolization is associated with need for HD during the index admission. Further research is required to understand the impact of angioembolization on renal functional outcomes long-term.
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