Traumatic kidney injuries A systematic review and meta-analysis new.pptx

Traumatic kidney injuries A systematic review and meta-analysis new.pptx

1. By : Ni Nyoman Amik Indrayani Traumatic kidney injuries : A systematic review and meta-analysis

2. INTRODUCTION Renal injury, although uncommon, is not rare.These injuries can present with different patterns, which often entails complex diagnostic and therapeutic evaluation

3. METHODS Data Source and Strategy A literature search was performed using Medline, Pubmed , Embase, and Scopus. B. Study Selection Criteria Article included were original and human subject articles. Articles excluded were those not involving human patients, cancer related, iatrogenic injuries, pediatric patients, and case reports C. Data Extraction The data extracted from the articles included in this review was performed using a data extraction table with the following categories: Author, year of publication, type of study, number of patients, age, gender, Injury Severity Score (ISS), mechanism of injury (blunt vs. penetrating), injury degree based on the American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS), modality of kidney injury diagnosis, and type of treatment.

4. METHODS D. Statistical Methods Demographics characteristics were presented using frequency (percentage) or mean as appropriate. Odds ratios (OR) with 95% confidence intervals comparing blunt mechanism among operative and non-operative groups.

5. Renal injury, although uncommon, is not rare. These injuries can present with different patterns, which often entails complex diagnostic and therapeutic evaluation RESULTS INCIDENCE Traumatic renal injury is infrequent, with rates between 1.4% and 3.2% of trauma victims. MECHANISM OF INJURY The most common mechanism for renal injury is blunt trauma, although there are a few reports that suggest a higher frequency of penetrating renal injury than described in the literature. ASSOCIATED INJURIES Isolated injury in only 28% of the cases of which up to 48% of the time was due to blunt trauma. Isolated renal injury was present in 8% of patients with penetrating injury. When there is a combined renal and colonic injury, penetrating is the most common mechanism of injury (96.5%)

6. DIAGNOSIS Hematuria FAST An intravenous urography was performed and if extravasation was seen or a lesion of the calyces or a decrease in renal function, an arteriography was performed Computerized Tomography (CT) has improved exponentially and allows for the ability to identify vascular, parenchymal and collecting systems in detail Magnetic Resonance Imaging (MRI) has been described in the literature when contrast is contraindicated or CT is not available Pyelografi Decreasing renal function Surgery

7. INJURY CLASSIFICATION Historically, the most frequent injuries have been grade I (28%), followed by grade II (26%), grade III (19%), grade IV (18%), and grade V (9%). In our review, the degree of injury was only reported in 26 out of the 46 papers representing 38,087 of patients. The most frequent injury was grade I (12,222; 32%), followed by grade IV (9,580; 25%), grade III (8,362; 22%), grade II (5,964; 16%), and grade V (1,959; 5%)

8. DISCUSSION Management of traumatic renal injuries has undergone a paradigm shift towards non operative management (NOM) during last decade NOM has become the standard in the most patients in renal trauma, even in those of high grade with success rate up to 80 % in hemodynamically stable patients Implementation of angioembolization for the treatment of active bleeding complications has established an intermediate step between traditional surgery and NOM The factors that will determine the choice of management are the patient's stability, the grade of renal injury and the presence of associated injuries.

9. DISCUSSION With an unstable patient, once the decision to perform a surgical approach has been made, it is essential to control the active bleeding and intestinal contamination during the laparotomy NOM is favored whenever possible and consists of rest, intravenous hydration and sometimes prophylactic antibiotic therapy Historically, all grades I and II injuries have been treated conservatively. The management of grade III injury has been controversial, although recent studies have shown that NOM is the management of choice. In grades IV and V surgery is often indicated due to other associated concomitant injuries

10. DISCUSSION Morbidity Early complication : bleeding, abscesses, hypertension, infections, and fistulae Late complication : Hydronephrosis, renal lithiasis, chronic pyelonephritis, pseudoaneurysms and arteriovenous fistulae Mortality Mortality in patients who received NOM treatment was 5.5% while those treated with an interventional approach had a mortality rate of up to 13.4

11. CONCLUSIONS When a renal injury is suspected, meticulous clinical and radiological evaluation are necessary to perform an adequate staging of the injury and to identify other possible associated injuries Renal injury NOM has become the standard in renal trauma management with good results in morbidity and mortality. When an invasive treatment is necessary, angioembolization for active bleeding or nephrorrhaphy is usually sufficient.

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