Renal trauma in the multiple injured patient.

Immediate radiological evaluation of renal injuries by a large dose or infusion excretory urogram resulted in a definitive diagnosis in 87% of the cases. Further radiological evaluation or exploration was required to make a definitive diagnosis in the remaining 13%. Blunt external trauma was responsible for 94% of the renal injuries. Less morbidity and a sharp reduction in delayed renal operation followed the introduction of immediate surgical management with the more severe types of renal injury. Clamping of the renal vessels prior to opening Gerota's fascia prevents reactivation of hemorrhage and allows for a deliverate operation with conservation of undamaged renal tissue. Associated injuries were present in 73% of the patients, including intra-abdominal injuries in 42%. The over-all nephrectomy rate of 5% in this study compares favorably to the nephrectomy rate in studies reporting the expectant management of renal injuries.