title: Salvageability of kidney in Grade IV renal trauma by minimally invasive treatment methods.
abstract: BACKGROUND
  Renal trauma is increasingly being managed conservatively. Grade I-III injuries are managed conservatively whereas Grade V injuries may end in surgery. Managing Grade IV renal trauma is individualized and managed accordingly.
  
  
  OBJECTIVE
  To evaluate retrospectively all Grade IV renal injuries managed in our institute over five years and to review the available literature.
  
  
  METHODS
  Reviewing the records of patients who sustained renal trauma and study all Grade IV renal injuries.
  
  
  METHODS
  We retrospectively analyzed all Grade IV renal injuries (16) managed at our institute between July 2008-August 2013. All patients were treated conservatively initially by hemodynamic stabilization, strict bed rest, if required endoscopic procedures. These patients were followed up with CECT.
  
  
  METHODS
  Descriptive statistics was performed using Microsoft excel spreadsheet 2007. Continuous data were described as mean and range. Categorical data was described as percentages.
  
  
  RESULTS
  Sixteen patients with Grade IV renal injury were included in the study. All patients had gross hematuria and 15 had urinary extravasation. D-J Stenting was done in 7 patients; perinephric tube drainage with D-J stentingwas done in 2 patients. One required selective upper pole arterial embolisation. Nephrectomy was not required in any of the patients. In the follow-up period, no patient had delayed complications.
  
  
  CONCLUSIONS
  Successful conservative management of Grade IV renal trauma requires constant monitoring both clinically and radiologically, and if properly managed, kidneys can be salvaged in all stable patients as reinforced by our study.
authors.affiliation: Department of Urology and Renal Transplantation, Narayana Medical College, Chintareddypalem, Nellore, Andhra Pradesh, India.
authors.forename: Surya V
authors.initials: SV
authors.lastname: Prakash
authors.affiliation: Department of Urology and Renal Transplantation, Narayana Medical College, Chintareddypalem, Nellore, Andhra Pradesh, India.
authors.forename: Chandra G
authors.initials: CG
authors.lastname: Mohan
authors.affiliation: Department of Urology and Renal Transplantation, Narayana Medical College, Chintareddypalem, Nellore, Andhra Pradesh, India.
authors.forename: Vijaya Bhaskar G
authors.initials: VB
authors.lastname: Reddy
authors.affiliation: Department of Urology and Renal Transplantation, Narayana Medical College, Chintareddypalem, Nellore, Andhra Pradesh, India.
authors.forename: Vijay Kumar V
authors.initials: VK
authors.lastname: Reddy
authors.affiliation: Department of Urology and Renal Transplantation, Narayana Medical College, Chintareddypalem, Nellore, Andhra Pradesh, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Radiology, Narayana Medical College, Chintareddypalem, Nellore, Andhra Pradesh, India.
authors.forename: Uma Maheshwar V
authors.initials: UM
authors.lastname: Reddy
keywords: Conservative management; renal artery embolisation; renal trauma; urinary extravasation