CONSERVATIVE MANAGEMENT OF GRADE 4 RENAL INJURIES – SINGLE CENTRE EXPERIENCE

Dr. Balasubramaniam .R; Dr. Saravanan .T; Dr. Saravanan K; Dr. Govindarajan .P

Volume : VIII, Issue : VI, June - 2018

CONSERVATIVE MANAGEMENT OF GRADE 4 RENAL INJURIES – SINGLE CENTRE EXPERIENCE

Dr. Balasubramaniam . R, Dr. Saravanan . T, Dr. Saravanan K, Dr. Govindarajan . P

Abstract :

Introduction: Grade 4 renal injuries are difficult to manage conservatively. Here we present our institutional experience in managing grade 4 renal injuries conservatively.

Aim:As per review and literature, only 25% grade 4 renal injuries are manged conservatively. This case series highlights the outcome of grade 4 renal injuries being managed conservatively in our institution.

Materials and Methods:This is prospective study of trauma cases categorized as grade4 renal injuries, which had been managed conservatively in our trauma department. This case series includes 15 cases of grade 4 renal injuries admitted in our trauma department. All these cases were due to blunt trauma and presented with hematuria initial resuscitation with iv fluids ,nasal o2, blood transfusion and higher antibiotics done and strict bed rest advised. CECT is the primary modality of investigation. 2 of the cases subjected to CT angiography too. Out 15 cases 8 cases were managed efficiently with above said conservative approach. 4 cases underwent nephrectomy. 2 cases expired due to associated poly trauma. 1 case renorraphy was done. All these 8 cases were followed up with serial CT scan and discharged in stable condition.

Conclusion:Though it is very difficult to manage grade 4 renal injuries conservatively, proper resuscitation and strict bed rest yields better results with more conservative approach.

Results:More than 50% of the grade 4 renal injuries could be managed conservatively if proper initial resuscitation and monitoring are done.