title: Criteria for nonoperative treatment of significant penetrating renal lacerations.
abstract: OBJECTIVE
  We developed criteria for nonoperative treatment of penetrating renal injuries and predicting which patients will benefit from immediate surgery.
  
  
  METHODS
  We reviewed the records of 120 patients with grades 2 to 4 renal lacerations from gunshot and stab wounds, of whom 41 were treated nonoperatively (group 1) and 79 underwent immediate renal exploration (group 2).
  
  
  RESULTS
  Group 1 had significantly lower incidences of gunshot wounds, shock, associated injuries, need for transfusion and high grade renal injuries. In patients with grade 2 lacerations no complications resulted from nonoperative treatment. However, 23.5% of patients in group 1 with grades 3 and 4 injuries had delayed renal bleeding versus none in group 2.
  
  
  CONCLUSIONS
  Nonoperative treatment of penetrating renal lacerations is appropriate in hemodynamically stable patients without associated injuries. Grade 2 injuries can be treated nonoperatively but grades 3 and 4 injuries are associated with a significant risk of delayed bleeding if treated expectantly. Exploration should be considered if laparotomy is indicated for other injuries.
authors.affiliation: Department of Urology, University of California School of Medicine, San Francisco, USA.
authors.forename: H
authors.initials: H
authors.lastname: Wessells
authors.forename: J W
authors.initials: JW
authors.lastname: McAninch
authors.forename: A
authors.initials: A
authors.lastname: Meyer
authors.forename: J
authors.initials: J
authors.lastname: Bruce
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007668:Kidney / Q000293:injuries*; D008875:Middle Aged; D014950:Wounds, Penetrating / Q000150:complications / Q000628:therapy*