Selective Management of Isolated and Nonisolated Grade IV Renal Injuries

Management of grade IV renal injuries is complex and demanding if renal salvage is to be achieved. Selective operative vs nonoperative management is based on the presence of associated nonrenal injuries, the hemodynamic stability of the patient, the degree of renal staging and the skill of the surgeon. Isolated grade IV renal injuries represent a unique situation to treat the patient based solely on the extent of the renal injury, thus nonoperative management is used more frequently. Persistent bleeding represents the main indication for renal exploration and reconstruction. In all cases of severe renal injury nonoperative management should only occur after complete renal staging in hemodynamically stable patients.