title: Renal trauma from recreational accidents manifests different injury patterns than urban renal trauma.
abstract: OBJECTIVE
  The majority of blunt renal trauma is a consequence of motor vehicle collisions and falls. Prior publications based on urban series have shown that significant renal injuries are almost always accompanied by gross hematuria alone or microscopic hematuria with concomitant hypotension. We present a series of blunt renal trauma sustained during recreational pursuits, and describe the mechanisms, injury patterns and management.
  
  
  METHODS
  Database review from 1996 to 2009 identified 145 renal injuries. Children younger than age 16 years, and trauma involving licensable motor vehicles, penetrating injuries and work related injuries were excluded from analysis. Grade, hematuria, hypotension, age, gender, laterality, mechanism, management, injury severity score and associated injuries were recorded.
  
  
  RESULTS
  We identified 106 patients meeting the criteria and 85% of the injuries were snow sport related. Age range was 16 to 76 years and 92.5% of patients were male. There were 39 grade 1 injuries, 30 grade 2, 22 grade 3, 12 grade 4 and 3 grade 5 injuries. Gross hematuria was present in 56.7%, 77.2% and 83.3% of grade 2, grade 3 and grade 4 injuries, respectively. None of the patients with grade 2 or greater injuries and microscopic hematuria had hypotension except 1 grade 5 pedicle injury. The nephrectomy and renorrhaphy rate for grade 1 to grade 4 injuries was 0%.
  
  
  CONCLUSIONS
  Compared to urban series of blunt renal trauma, recreationally acquired injuries appear to follow different patterns, including a paucity of associated injuries or hypotension. If imaging were limited to the presence of gross hematuria, or microscopic hematuria with hypotension, 23% of grade 2 to grade 4 injuries would be missed. Men are at higher risk than women. However, operative intervention is rarely helpful.
authors.affiliation: Department of Urology, University of Wisconsin, Madison, Wisconsin, USA. Lloyd@Urology.Wisc.Edu
authors.forename: Granville L
authors.initials: GL
authors.lastname: Lloyd
authors.forename: Sean
authors.initials: S
authors.lastname: Slack
authors.forename: Kelly L
authors.initials: KL
authors.lastname: McWilliams
authors.forename: Aaron
authors.initials: A
authors.lastname: Black
authors.forename: Tristan M
authors.initials: TM
authors.lastname: Nicholson
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D000058:Accidental Falls; D000293:Adolescent; D000328:Adult; D000368:Aged; D003120:Colorado / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D011998:Recreation; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices; D014504:Urban Health / Q000706:statistics & numerical data; D014505:Urban Population; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult