Does nephrectomy for trauma increase the risk of renal failure?
Renal failure is a feared complication following operations for severe trauma. Injuries to the kidney may be managed by nephrectomy or nephrorrhaphy. Nephrectomy may increase the risk of renal failure in already at-risk trauma patients. Nephrectomy for trauma should be avoided to the extent possible because it is associated with renal failure. From a prospectively collected trauma database, 59 patients with nephrectomy were matched at 1:1 ratio with 59 patients with nephrorrhaphy. Matching criteria were age (+/- 5 years), Injury Severity Score (+/- 3), abdominal Abbreviated Injury Score (+/- 1), and mechanism of injury (blunt or penetrating). The rates of renal function compromise (defined as a serum creatinine level >2 mg/dl for more than 2 days) and renal replacement therapy (continuous or intermittent) were compared in the two groups. The two groups were well-matched and similar with regard to injury severity and organs injured. Between nephrectomy and nephrorrhaphy patients, there were no differences in renal function compromise (10% vs. 14%, p = 0.57), renal replacement therapy (5% vs. 0%, p = 0.12), length of hospital stay (19 +/- 26 vs. 20 +/- 21, p = 0.8), and mortality (15% vs. 12%, p = 0.59). Salvaging the injured kidney does not seem to offer an obvious clinical benefit regarding postoperative renal function. Given the increased operative complexity of nephrorrhaphy in comparison to nephrectomy and the frequent need to abbreviate the operation in patients with severe trauma, nephrectomy should not be avoided when appropriate.
Velmahos
George C
GC
Department of Surgery, Division of Trauma and Critical Care, Los Angeles County and University of Southern California Medical Center, 1200 N. State Street, Los Angeles, California 90033, USA. gvelmahos@partners.org
Constantinou
Constantinos
C
Gkiokas
George
G
D015998:Abbreviated Injury Scale; D000328:Adult; D006801:Humans; D007668:Kidney / Q000293:injuries* / Q000601:surgery*; D009392:Nephrectomy / Q000009:adverse effects; D011183:Postoperative Complications / Q000453:epidemiology*; D051437:Renal Insufficiency / Q000453:epidemiology*; D018570:Risk Assessment; D013536:Suture Techniques; D016896:Treatment Outcome