The injured kidney.

From over 200 cases of suspected kidney injury, 84 proved cases were selected for analysis of diagnostic methods, management techniques, and sequelae. The degree of renal injury was classified according to radiographic findings as severe, moderate, minimal, or negligible. Diagnostic criteria included history of trauma, demonstrable hematuria, physical findings, and radiographic evidence. Retrograde pyelography proved diagnostic in 18 of 20 patients, while excretory pyelograms were diagnostic in 31 of 66 patients. Two patients died; 9 required renal surgery; 52 were followed 2 months or more; 5 developed hypertension as a consequence of renal injury, and in 9 cases there were persistent radiographic renal defects. The study indicates that radiographic classification of renal injury provides a key to clinical management, that most kidney injuries may be managed conservatively, that some renal injuries may result in permanent damage or hypertension, and that, if the complications of renal trauma are to be appreciated, persistent follow-up is essential.