Effect of renal angioembolization on post-traumatic acute kidney injury after high-grade renal trauma: a comparative study of 52 consecutive cases.
BACKGROUND
Acute kidney injury (AKI) is associated with unfavourable outcomes and higher mortality after trauma. Renal angioembolization (RAE) has proved efficiency in the management of high-grade renal trauma (HGRT), but inevitably expose to unavoidable ischaemic areas or contrast medium nephrotoxicity which may impair renal function in the following hours. The aim of this study was to assess the potential acute impact of RAE on renal function in a consecutive series of HGRTs treated nonoperatively.


METHODS
Of 101 cases of renal trauma admitted to our Regional Trauma Center between January 2005 and January 2010, 52 cases of HGRT were treated nonoperatively; they were retrospectively classified into 2 groups according to whether RAE was used. Incidence and progression of AKI (RIFLE classification), maximum increase in serum creatinine (SCr), level since admission and recovery of renal function at discharge were compared between the groups. Multivariable analysis was performed to determine the role of RAE as an independent risk factor of AKI.


RESULTS
RAE was performed in 10 patients within the first 48h. The RAE and no RAE groups were comparable in terms of severity score, renal injury grade, and level of SCr on admission. AKI incidence (RIFLE score Risk or worse) after 48 and 96h was 33% and 10%, respectively and did not differ significantly between groups at 48h (p=1.00) or 96h (p=1.00). The median maximum increase in SCr was significantly higher in no RAE than RAE group (30.4% vs. 6.9%, p=0.04). RAE was not found to be a significant variable in a multiple linear regression analysis predicting maximum SCr rise (p=0.34). SCr at discharge was >120% of baseline in only 5 patients, with no difference according to RAE (p=0.24).


CONCLUSIONS
In a population of nonoperatively treated HGRT, the incidence of AKI decreased from almost 30% to 10% at 48h and 96h. RAE proceeding did not seem to affect significantly the occurrence and course of AKI or renal recovery. The decision to use RAE should probably not be restricted by fear of worsening renal function.
Department of Anesthesiology and Critical Care, Lapeyronie Hospital, Montpellier I University, Montpellier, France.
M
M
Saour
Department of Anesthesiology and Critical Care, Lapeyronie Hospital, Montpellier I University, Montpellier, France. Electronic address: j-charbit@chu-montpellier.fr.
J
J
Charbit
Department of Radiology, Lapeyronie Hospital, Montpellier I University, Montpellier, France.
I
I
Millet
Department of Interventional Radiology, Arnaud de Villeneuve Hospital, Montpellier I University, Montpellier, France.
V
V
Monnin
Department of Radiology, Lapeyronie Hospital, Montpellier I University, Montpellier, France.
P
P
Taourel
Department of Critical Care, Lapeyronie Hospital, Montpellier I University, Montpellier, France.
K
K
Klouche
Department of Anesthesiology and Critical Care, Lapeyronie Hospital, Montpellier I University, Montpellier, France; Institut National de la Santé et de la Recherche Médicale, Equipe Inserm U1046, Montpellier F-34295 Cedex 5, France.
X
X
Capdevila
D000007:Abdominal Injuries / Q000150:complications* / Q000401:mortality; D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D000328:Adult; D003404:Creatinine / Q000097:blood; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D011379:Prognosis; D012077:Renal Artery; D012189:Retrospective Studies; D012307:Risk Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome
D003404:Creatinine
Acute kidney injury; Contrast media associated nephrotoxicity; RIFLE score; Renal angioembolization; Renal trauma