Patients with the most severe blunt trauma to the kidney may be managed without surgery, researchers reported.

In a 12-year retroactive analysis of people with grade IV or V blunt renal injury who were hemodynamically stable, nonoperative management was successful in more than 90 percent of patients treated without surgery, according to George Velmahos, MD, PhD, of Massachusetts General Hospital in Boston, and colleagues.

They found that renal injuries were the cause of treatment failure in only 6.5% of those initially managed without surgery, according to their report inJAMA Surgery.

In the American Association for the Surgery of Trauma Organ Injury Scale, grade IV injuries indicate lacerations that extend to the renal pelvis, and grade V injuries indicate a shattered kidney or renal artery injuries with parenchymal devascularization.

The nonoperative approach has become the "preferred way" to treat blunt kidney trauma, the authors noted, but evidence is limited for patients with high-grade injuries to the organ.

They looked at outcomes of 206 patients -- 52 with grade V and 154 with grade IV injuries -- admitted between Jan. 1, 2000 and Dec. 31, 2011 to 12 level I and II trauma centers in New England.

Of those, 52 underwent immediate surgery, 26 each with grade IV and V injuries. The remaining 154 were initially managed nonoperatively, including 126 with grade IV and 26 with grade V injuries.

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