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  • br Introduction Worldwide trauma is currently the sixth lead

    2019-06-11


    Introduction Worldwide, trauma is currently the sixth leading cause of death, accounting for 10% of mortalities. The urogenital system has consistently been shown to be involved in 10% of patients presenting after trauma and is a significant factor in trauma-induced morbidity and mortality. Renal injuries have been reportedly encountered by trauma surgeons, accounting for 1–3% of all traumatic injuries. There are many mechanisms for injury. Usually, when associated with unstable hemodynamics or other organ injuries, patients require surgical exploration. The most common management of renal injury is nephrectomy. Renal function insufficiency after renal injuries or after treatments occur frequently; they often correlate with increased mortality. Thus, the ability to rescue the extent of Silmitasertib function loss is an important factor when assessing outcomes after renal injuries. The treatment of renal trauma has changed from surgical exploration to an approach that conserves nephrons. Currently, many methods are used to prevent nephron loss, including partial nephrectomy, renal neoplasty, selective transcatheter angiographic embolization (TAE), and nonoperative management. Although there is an increasing number of patients undergoing nonoperative management of penetrating renal trauma in clinical practice, TAE has been widely used to manage renal trauma, and it has been confirmed as an effective tool. However, owing to circumstances of skill or situation, such as in disaster assistance or field relief environment, use of TAE may be rendered nearly impossible.
    Methods
    Results
    Discussion The kidney is the most commonly injured organ in all abdominal trauma cases. There are many prognostic factors for patients, including the stage of injury, the mechanism of injury, and surgical exploration or nephrectomy. The key point of deeply wounded patient survival has been early hemostasis. However, the loss of renal function is often neglected. Benefits of renal salvage include decreased mortality rates and decreased risks for developing chronic kidney disease. Surgical repairs must be performed within 4 hours of injury in order to preserve renal function. However, only 14–29% of kidneys are ever restored to normal function. Thus, in this report, we describe our experience with a new damage control method to evaluate the extent of renal protection in canines with renal injuries. We found that TTBR was a safe and reliable method to treat renal injury in our field shelter. This approach would be able to protect renal function better. There was a reliable consistency between hemostasis time and the extent of residual renal injury, which indicated that rapid hemostasis is a feasible method. The treatment of unstable renal injuries includes nonoperative management, TAE, and renal exploration, and then even nephrectomy or renal neoplasty. However, it is still under debate what the sequence of these treatment steps should be. The chosen method could be based on the Organ Injury Scaling for Kidney Trauma developed by the American Association for the Surgery of Trauma (AAST OIS). Most renal injuries, especially blunt trauma, are managed nonoperatively. Observation and resuscitation alone is sufficient treatment for most traumatic renal injuries as most are of lower grade. High-risk cases are very likely to benefit from TAE, renal repair, or nephrectomy to stop fatal hemorrhage. There are many conflicting views in grading injuries. Management for renal trauma has changed dramatically since the AAST OIS publication two decades ago. Many unnecessary explorations and increased nephrectomy rates have appeared. Many patients have lost organs because of misgrading; their organs should have been preserved. Therefore, several other variables are routinely considered adjuncts. Nonoperative methods remain controversial. In a recent review of the clinical management of renal injuries, the medical literature reported a nonoperation rate of 30.4–32% since 2000. The published data support increasing conservative attempts in hemodynamically stable patients. The aim of conservative management is to minimize the Silmitasertib incidence of unnecessary repairs and decrease iatrogenic nephrectomy rates. Patients who were managed conservatively had a higher rate of renal complications, including anemia, fever, hematuria, pseudoaneurysm formation, arteriovenous fistula, post-traumatic renovascular hypertension, and delayed bleeding. There are many dangers of secondary operation for the complications. If the renal fascia becomes violated and renal cortical bleeding is noted, by packing the renal fossa too tightly, the kidney may atrophy. Furthermore, nonoperative treatment requires infusion, braking, and observation. These could not be supported under certain environments, such as battlefields. Patients with associated injuries also may need laparotomy. Gunshot injuries or other penetrating injuries often call for debridements.