title: Death or dialysis? The risk of dialysis-dependent chronic renal failure after trauma nephrectomy.
abstract: Although renal trauma is increasingly managed nonoperatively, severe renovascular injuries occasionally require nephrectomy. Long-term outcomes after trauma nephrectomy are unknown. We hypothesized that the risk of end-stage renal disease (ESRD) is minimal after trauma nephrectomy.  We conducted a retrospective review of the following: 1) our university-based, urban trauma center database; 2) the National Trauma Data Bank (NTDB); 3) the National Inpatient Sample (NIS); and 4) the U.S. Renal Data System (USRDS). Data were compiled to estimate the risk of ESRD after trauma  nephrectomy in the United States. Of the 232 patients who sustained traumatic renal injuries at our institution from 1998 to 2007, 36 (16%) underwent a nephrectomy an average of approximately four nephrectomies per year. The NTDB reported 1780 trauma nephrectomies from 2002 to 2006, an average  of 356 per year. The 2005 NIS data estimated that in the United States, over 20,000 nephrectomies are performed annually for renal cell carcinoma. The USRDS annual incidence of ESRD requiring hemodialysis is over 90,000, of which 0.1 per cent (100 per year) of renal failure is the result of  traumatic or surgical loss of a kidney. Considering the large number of nephrectomies performed for cancer, we estimated the risk of trauma nephrectomy causing renal failure that requires dialysis to be 0.5 per cent. National data regarding the etiology of renal failure among patients with  ESRD reveal a very low incidence of trauma nephrectomy (0.5%) as a cause; therefore, nephrectomy for trauma can be performed with little concern for long-term dialysis dependence.
authors: Department of Surgery, University of California, San Francisco-East Bay, Alameda County Medical Center, Oakland, California 94602, USA.
authors: Kristopher C
authors: KC
authors: Dozier
authors: Louise Y
authors: LY
authors: Yeung
authors: Marvin A
authors: MA
authors: Miranda
authors: Emily J
authors: EJ
authors: Miraflor
authors: Aaron M
authors: AM
authors: Strumwasser
authors: Gregory P
authors: GP
authors: Victorino
mesh_terms: D016208:Databases, Factual; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007668:Kidney / Q000293:injuries* / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D009392:Nephrectomy; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D006435:Renal Dialysis; D012189:Retrospective Studies; D012306:Risk; D014481:United States / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000601:surgery*; D014950:Wounds, Penetrating / Q000401:mortality / Q000601:surgery*