Blunt renal injuries of intermediate degree

Our experience with 104 cases of blunt renal trauma included 20 injuries of intermediate degree. Of this group, urinary extravasation (60 per cent) and parenchymal laceration (100 per cent) were predominant features exhibited by conventional radiographic studies. Both findings do not require surgical intervention and spontaneous resolution can be anticipated. Nephrectomy (9 cases) and heminephrectomy (2 cases) were perhaps performed unnecessarily in this group since 9 similar patients managed either conservatively (7 cases) or subjected to minor operative procedures on the kidney (2 cases) responded with total functional and anatomic recovery. Arteriography is at times recommended since it can provide information that will give confidence in the conservative management of some cases.     

Evaluation of the management of blunt renal trauma and indication for surgery

OBJECTIVES: Appropriate management of renal trauma is still controversial. Many of the patients have minor injuries and conservative treatment can achieve excellent outcomes without any complications. For major injuries of deep lacerations or ruptures, we have been performing early surgical treatment to salvage the kidney in the selected cases after the precise evaluation of the injury. To obtain the optimal management options, we evaluated the clinical results of our procedures. PATIENTS AND METHODS: We conducted a retrospective study, which included 106 cases of blunt renal trauma with evident etiology over the past 22 years and 9 months. The severity of the injury was evaluated mainly by CT scanning. The indication of renal exploration included persistent renal bleeding, large hematoma around the kidney, dislocated fragments, nonviable tissue, massive urinary extravasation and vascular injury. With the patients who required an operation, we first controlled the bleeding by clamping the hilar vessels. Then, the final decision whether to repair or remove the kidney was made based on the direct inspection of the injured kidney after the complete removal of the hematoma. The severity of renal trauma was classified by the classifications found in The Organ Injury Committee of the American Association for the Surgery of Trauma. RESULTS: Sixty-three patients were managed conservatively without any interventions, while 22 surgical repairs and 21 nephrectomies were performed. Of the 63 patients, 35 patients (81.4%) were operated on within 2 days after the injury. Judging from systolic blood pressure, red cell count, blood loss during surgery and transfusion requirements, surgically treated patients were more severely injured than conservatively treated patients. And nephrectomized patients than surgically repaired patients. All the surgically repaired cases were confirmed to have preserved renal functions postoperatively. In all of the 50 patients with Grade I injuries, conservative treatment was successful. Eight out of the 19 Grade II and III cases, who were indicated for kidney exploration because of multiple lacerations or considerable bleeding, were also successfully repaired. Localized hematoma with no urine leakage, even when it was large, settled spontaneously without complication. For the 37 Grade IV and V injuries, including 4 cases with hilar injuries, we implemented conservative procedures on 2 patients, surgical repair on 14 patients and nephrectomy on 21 patients. In the conservatively treated cases, one deep laceration with relatively large, but localized, hematoma, and minimal urine extravasation healed spontaneously. Atrophy of the segment and hypertension developed in the other ruptured kidney with dislocated fragments, large hematoma and urine leakage. This kidney, which also required later surgical exploration, did have good parenchymal blood flow. Hilar injury cases were all resulted in nephrectomy. CONCLUSION: In most of our cases the indication for surgical exploration or nephrectomy based on our criteria seemed to be properly decided. Several cases, though, might have received overtreatment. Recent advances in evaluations and strategies of renal trauma have decreased the need for surgical exploration. This may have overreached the indication for conservative management. Severely injured kidneys may be managed conservatively because in most cases bleeding settles after the full formation of large hematoma within the Gerota's fascia. In such cases, though, no one can predict whether the injury will heal spontaneously or not, and, moreover, whether a complication will develop or not. We think that the optimal management of the patient requires an accurate evaluation of the injured kidney. Therefore the indication for surgical exploration should be made based on the degree of the injury.     

A conservative approach to major blunt renal lacerations with urinary extravasation and devitalized renal segments

OBJECTIVES: To determine the feasibility of a conservative (expectant) approach to major blunt renal laceration with urinary extravasation and devitalized renal segments. PATIENTS AND METHODS: All patients treated conservatively who presented between 1990 and 1999 with major renal laceration (grade 4 and 5) were retrospectively reviewed to determine whether urinary extravasation and devitalized segments adversely affected the outcome. For each patient the data collected included the initial emergency department evaluation, findings on computed tomography, associated injuries, duration of hospital stay, transfusion requirements, complications and follow-up imaging. RESULTS: Of 20 patients who sustained blunt trauma resulting in a major renal laceration (five grade 5 and 15 grade 4) with urinary extravasation, 11 had coexisting devitalized segments. There was a statistically significant difference in the length of hospital stay (16.3 vs 7.3 days), blood transfusions (six vs two patients, P < 0.08) and the need for delayed surgical intervention (nine vs two, P < 0.01) between patients with and with no devitalized segments, respectively. Urinary extravasation spontaneously resolved in two of 11 patients with and in seven of nine with no devitalized segment, respectively (P < 0.05) CONCLUSIONS: Urinary extravasation will resolve spontaneously in most patients with blunt renal trauma, and expectant treatment does not adversely affect the outcome or prolong hospitalization. In patients who present with a major renal laceration associated with devascularized segments, conservative management is feasible in those who are clinically stable with blunt trauma. However, the physician must be especially aware of the probable complications within this subset of patients.     

Efficacy of Radiographic Imaging in Pediatric Blunt Renal Trauma

Purpose

We sought to determine whether radiographic imaging can effectively detect significant renal injuries in children with blunt trauma who do not have significant hematuria.

Materials and Methods

We reviewed the records of 180 children who presented to our hospital for suspected renal trauma between 1977 and 1995. Results of excretory urography or abdominal computerized tomography were correlated with urinalysis findings and clinical outcome.

Results

Of 147 patients with microscopic hematuria after blunt trauma 77 underwent imaging. Only 1 patient had a significant renal injury (grade 2 or greater) and 76 had normal findings or renal contusions only, including 11 with microscopic hematuria and shock. Of the 74 patients who did not undergo imaging a clinical diagnosis of renal contusion was made and followup was available for 57 (77 percent). All patients healed without adverse sequelae. Of 33 patients with gross hematuria significant renal injuries were found in 9, including 3 who required immediate surgical repair of a major renal laceration or vascular injury. Combining our results with those of other reported series revealed significant renal injuries in only 11 of 548 children (2 percent) with less than 50 red blood cells per high power field on presenting urinalysis after blunt abdominal trauma. These patients were likely to have multiple associated injuries.

Conclusions

Significant renal injuries are unlikely in pediatric patients with blunt renal trauma but no gross or substantial microscopic hematuria. Shock does not appear to be a clinically useful indicator.     

Conservative... and non conservative... treatment of renal blunt injuries

Whether patients with blunt renal trauma should be managed conservatively without surgery or undergo surgery is often hard to decide. We describe three clinical cases of blunt renal trauma, all involving the left kidney. All three patients had abdominal ultrasound studies and computerized tomographic (CT) scans. In the first case, an accidental fall led to severe injury of the renal hilus causing massive retroperitoneal extravasation. The patient underwent emergency nephrectomy and survived. The second case concerned a patient who was involved in a road accident, suffered injuries mainly affecting the spleen, and underwent splenectomy. A postoperative CT scan showed left renal vein thrombosis functionally excluding the inferior pole of the kidney. The patient received conservative non surgical treatment. A follow-up imaging study showed that although the thrombosis had resolved the renal pole had failed to regain normal function. In the third case, mild apparently unimportant trauma led to a massive hemorrhage responsible for a severe shock state. Despite prompt nephrectomy, renal failure and and pulmonary complications developed and one month after the injuries the patient died. The medical history referred to a "chronic hematoma" secondary to a childhood injury. In this case, the pre-existing hematoma probably led to a permanent communication with the vascular and excretory tree thus resulting in a kind of "silent" fistula that the relatively mild injury unexpectedly disrupted. For the two left nephrectomies we used a midline approach after isolating the renal Treitz vessels; special care was taken to mobilize the left colon. Although blunt renal trauma often responds to non surgical conservative treatment, some patients should undergo prompt surgery. All patients must be scheduled for long-term clinical and imaging follow-up.     

Renal artery and vein injury following blunt trauma.

Blunt injuries of the renal vascular pedicle occur infrequently. The experience with fourteen cases of blunt renal vascular trauma is presented. Most patients were injured in motor vehicle accidents. The diagnosis was made immediately after admission in 6 patients, delayed in 5, and at autopsy in 3. Most patients presented with gross or microscopic hematuria. The diagnosis of renal vascular injury was suggested by IVP in most instances. Surgical management was used in the 6 patients in whom the immediate diagnosis of renal pedicle injury was made; primary vascular repair was carried out in 4 patients and nephrectomy in two. Conservative management was used in 4 of the 5 patients with delayed diagnosis, and nephrectomy was required in the fifth. Three patients received no treatment as two were dead on arrival and one die during laparotomy. Seven patients died (50%). One of the 7 survivors has a functioning kidney following repair of a renal vein laceration. Three patients with devascularized kidneys have been followed long term and have not developed hypertension. An IVP should be mandatory following severe blunt trauma, especially when hematuria is present. Renal arteriography is indicated with distortion of calyces, extravasation or nonfunction seen on IVP and allows a definitive diagnosis of renal vessel injury to be made.     

Clinical indications for radiographic evaluation of blunt renal trauma

The evaluation of patients with blunt renal trauma has become controversial. We tested the hypothesis that renal contusion can be diagnosed clinically and that these patients do not require radiographic evaluation. To evaluate the association of microhematuria without shock and with renal contusion, we reviewed the medical records of 831 patients with hematuria following blunt renal trauma. Microscopic hematuria without shock was noted in 160 of 241 patients without and 334 of 590 with associated injuries. Of the former 160 patients 159 had renal contusion and 1 had a renal laceration, while of the latter 334 patients 329 had renal contusion, 3 had renal laceration, 1 had renal rupture and 1 had a pedicle injury. Most patients with microscopic hematuria and no shock after blunt renal trauma had a renal contusion, especially those with no associated injury. All of the patients with renal contusions experienced no complications from nonoperative management. However, avoiding a radiographic evaluation in patients with blunt renal trauma plus microhematuria and no shock would miss a few cases of severe renal injury.     

Renal and ureteric trauma: diagnosis and management in Poland

OBJECTIVE: To analyse retrospectively kidney and ureteric injuries (the former often associated with multiple-organ trauma) and thus optimize diagnostic and treatment methods. PATIENTS AND METHODS: The records and details of kidney and ureteric injures treated between 1995 and 1999 in 61 urological departments in Poland were analysed. RESULTS: In all, 887 kidney injuries were analysed; blunt trauma comprised 97%, with most injuries classified as renal contusion and minor parenchymal damage (687 cases). Intravenous urography was used in 80% of the patients and computed tomography in only 20%. In all, 234 patients (26%) underwent surgery; nephrectomy was the most common surgical treatment, in 170 patients (73% of those undergoing surgery). Complications occurred in 9% of patients after conservative treatment and in 5% after surgery. Of the 452 ureteric injuries, 340 (75%) were iatrogenic, 81 (18%) blunt injuries and 31 (7%) open injuries. Of the iatrogenic injuries 73% occurred during gynaecological procedures, 14% in general surgery and 14% in urological procedures. The most frequent diagnostic method was intravenous urography (244 cases), with retrograde pyelography (98) and ureteric catheterization in 125. The diagnosis was established immediately during surgery in 104 patients. The most frequent surgical treatment was uretero-neocystostomy (213, 47%), the others being a Boari flap (113, 25%), end-to-end anastomosis (92, 20%), reconstruction with an ileal loop (30, 7%) and autotransplantation (four, 1%). CONCLUSION: In Poland, patients with blunt kidney injuries often undergo surgery, with nephrectomy the most frequent procedure. Computed tomography with the intravenous administration of contrast medium should be considered the diagnostic method of choice for kidney injures. Catheterization of the ureters before surgery and an indigocarmine intravenous infusion (to stain the urine) when a ureteric injury is suspected may reduce the rate of iatrogenic injury and improve the rate of intraoperative diagnosis. We suggest catheterizing the ureters in any doubtful case to avoid injury, because prevention is better than treatment.     

Immediate surgical management of severe renal injuries in multiple-injured patients

Between 1969 and 1980, 1,132 renal injuries were recorded in 1,120 patients. Of the 129 patients with a severe renal injury (laceration, rupture, pedicle injury), 118 (91%) had associated injuries and 101 (86%) required an immediate laparotomy by general surgeons for intra-abdominal injury. Immediate surgical management was performed on 90 severe renal injuries and resulted in a nephrectomy rate of 5 of 55 lacerations (9%), 16 of 17 ruptures (94%), and 10 of 18 pedicle injuries (56%). Seven of the 18 pedicle injuries (39%) had immediate repair with salvage of the kidney. Conservative management was done on 32 severe renal injuries. Autopsy revealed 10 severe renal injuries in 9 patients who died in the operating room or on admission. A delayed renal operation was required in 9 (28%), and total renal loss (nephrectomy plus main renal artery injury) occurred in 7 of the 32 cases (22%). The severe degrees of renal injury did not all resolve spontaneously. Immediate surgical management of the patient with a severe renal injury resulted in a nephrectomy rate comparable with that of conservatively managed renal injuries.     

Evaluation of 115 consecutive patients with blunt renal trauma by using the classification for renal injury of Japanese Association for the Surgery of Trauma

OBJECTIVE: To evaluate the clinical usefulness of the classification for renal injury, proposed by Japanese Association for the Surgery of Trauma (JAST). METHOD: JAST classification for renal injuries consists of categories as: Type I (subcapsular injury); Type II (superficial injury); type III (deep injury); type IV (pedicle injury). Type III injuries are subclassified into: IIIa (deep laceration); IIIb (transection); IIIc (fragmentation). Type IV are subclassified as: IVa (M), IVa (S) (the occlusion of main or segmental renal artery); IVb (renal vessels laceration). Each of the degrees of severity in hemorrhage (H factor) and extravasation of urine (U factor) should be appended as: H0, U0 (not recognized); H1, U1 (remaining within perinephric space); H2, U2 (extending through Gerota's fascia); H3, U3 (extending to contralateral side). We examined the initial management and overall outcome of blunt renal injuries recorded at our institute. All patients were classified according to the JAST criteria. Statistical analyses were applied to find the correlations between type and H factor, and between type and U factor. We also determined which parameter (type, H or U) is the most significant factor responsible for the outcome of treatment in the injured kidney. RESULT: One hundred and fifteen consecutive cases of blunt renal injuries from 1982 to 1999 were investigated. Significant correlations were observed between type (I-IIIc) and H factor, and also between type (IIIa-IIIc) and U factor. Twenty-nine patients (25%) underwent immediate surgical exploration; 1 (2%) in type I or II or IVa (S), 5 (18%) in IIIa, 4 (50%) in IIIb, 7 (100%) in IIIc and 12 (100%) in IVa (M) or IVb. Among the 86 conservatively-managed patients, TAE or surgical intervention was required later in six patients. Nineteen (17%) patients were nephrectomized. The renal loss rates were 0% in type I or II or IVa (S), 7% in IIIa, 25% in IIIb, 57% in IIIc and 92% in IVa (M) or IVb, respectively. The differences of severities of the type and the H factor are statistically significant between the groups of injured kidney preserved and lost. Logistic regression analysis suggested that the type was an independent factor predicting outcomes of injured kidneys. CONCLUSION: It seemed that the type category is most useful when managing patients with renal injuries and also evaluating outcomes of them.     

Blunt renal injury--an experience of 30 cases

Thirty cases of blunt renal injury are reviewed. The need for rapid and accurate diagnosis of these cases with excretory urography, supplemented in certain patients with renal angiography, is discussed. High-dose excretory urography allows the cases to be categorized into minor or major injuries. All minor injuries can be managed without operation. For major injuries, a conservative approach, if necessary followed by surgical exploration, avoids loss of organ in most of the cases.     

Operative indications in penetrating renal trauma

In a review of 53 patients with penetrating renal injuries treated between 1978 and 1983 at San Francisco General Hospital, we correlated several factors with the extent of renal damage to determine whether major and minor injuries could be differentiated preoperatively, thereby avoiding unnecessary surgical exploration. Of 56 injured kidneys (three patients had bilateral injuries), 35 sustained major injuries, 17 minor, and four vascular pedicle injuries. The presence of shock, the degree of hematuria, the location of the entry site, and the type of injury did not permit reliable discrimination among these categories. Intravenous urography was most often nondiagnostic, and only the presence of extravasation or nonfunction was specific for major injury. Computed tomography provided accurate preoperative assessment in 11 cases, however, allowing nonoperative management in eight renal injuries.     

Renal trauma in multiple-injured child

Between 1959 and 1981, 251 renal injuries occurred in 248 children up to the age of sixteen years. Of the 36 children with renal laceration, rupture, or pedicle injury, 35 (97%) had associated injuries; 31 of these children (89%) with associated injuries required an immediate laparotomy by general surgeons for intra-abdominal injury. Immediate surgical management was performed on 27 severe renal injuries and resulted in nephrectomy in 3 of 20 renal lacerations (15%), in 4 of 4 ruptures (100%), and in 1 of 3 pedicle injuries (33%). Two of the 3 pedicle injuries (67%) had immediate repair with salvage of the kidney. Conservative management was carried out in 10 severe renal injuries. Delayed renal surgery was required in 3 cases (30%) and total renal loss (nephrectomy plus main renal artery injury) occurred in 5 of the 10 cases (50%). The severe degrees of renal injury did not all settle by themselves. Immediate surgical management of the patient with a severe renal injury resulted in a nephrectomy rate comparable with that of conservatively managed renal injuries.     

Stab wounds associated with hematuria--a review of 67 cases

The clinical records of 67 patients who underwent surgical exploration for stab wounds associated with hematuria were reviewed in an attempt to evaluate the need for mandatory operation and to define criteria for possible nonoperative of such cases. Minor renal injuries without associated intra-abdominal lacerations were found in 61 per cent of the patients. Delayed renal hemorrhage occurred in 15 per cent of the patients despite early exploration, suture and drainage of the kidney, and antibiotic prophylaxis. Of 7 nephrectomies 5 were performed for secondary hemorrhage. Postoperative pulmonary complications arose in 28 per cent of the patients. A policy of mandatory operation on all patients with stab wounds and hematuria led to apparently needless surgery in 61 per cent of the patients in this series. Retrospective analysis revealed that the rate of probably unnecessary operations could have been reduced to 24 per cent by selecting for operation only those patients with signs of severe hemorrhage, associated intra-abdominal injury or major extravasation of contrast material on excretory urography.     

The role of interventional radiology in the management of blunt renal injury: a practical protocol

OBJECTIVE: The purpose of this study was to evaluate the efficacy of a protocol designed to minimize the need for surgery in the management of severe blunt renal injury. METHODS: Forty-six of 752 trauma patients had evidence of renal injury on computed tomographic (CT) scan. Two patients required emergency laparotomy, and the remaining 44 patients were classified by CT scan grade using the American Association for the Surgery of Trauma classification system. Patients with CT scan grade 3 or over underwent renal angiography. RESULTS: Twenty-one patients had a high-grade injury on CT scan (> or =3). Eight had angiographic evidence of extravasation from renal arterial branches and underwent transarterial embolization. One patient with a grade 5 injury had extravasation from a main renal vein and underwent immediate laparotomy. This was the only patient who required surgery for renal injury. CONCLUSION: Surgery can be avoided in most cases of blunt renal injury. Hemodynamic instability and injury to main renal veins remain indications for surgical exploration.     

Indications for radiographic assessment in suspected renal trauma

We recommend that the criteria for radiographic assessment of suspected renal trauma be: (1) penetrating trauma to the flank or abdomen, regardless of the degree of hematuria; (2) blunt trauma and gross hematuria; or (3) blunt trauma associated with microhematuria and blood pressure below 90 mm Hg before or after emergency room admission. In hemodynamically stable patients in whom renal injury alone is suspected, we recommend intravenous urography, which will adequately stage 60 to 85 per cent of renal injuries. Computed tomography should be performed if the urography results are equivocal or as the primary study when multiple injuries are suspected. Arteriography can be reserved for patients with suspected renovascular injuries in whom CT scans are inconclusive.     

Computerized tomographic staging of renal trauma: 85 consecutive cases

In 85 patients with renal trauma we compared the findings on computerized tomography with those of excretory urography, renal surgery, intra-abdominal surgery and angiography. Patients underwent computerized tomography because of a suspected associated thoracic or abdominal injury, or indeterminate findings on excretory urography, nephrotomography or angiography. Blunt trauma accounted for 87.1 per cent of the renal injuries and penetrating trauma for 12.9 per cent. The most common findings on computerized tomography were perirenal hematoma in 29.4 per cent, intrarenal hematoma in 24.7 per cent and parenchymal disruption in 17.6 per cent. In 33 patients who underwent laparotomy computerized tomographic staging was confirmed. In contrast, the most common finding on excretory urography, diminished opacification (17 of 53 patients), was found to have no correlation with the severity of renal injury as assessed by computerized tomography or laparotomy. Angiography appreciably understaged 1 of 5 cases by failing to show extracapsular extravasation with parenchymal disruption. All findings on angiography were depicted by computerized tomography. We conclude that computerized tomographic staging for renal trauma is more sensitive and specific than excretory urography, nephrotomography and angiography, and that it should be used primarily when multiple traumatic injuries are suspected, when excretory urography suggests major trauma or is nonspecific and when clinical evidence of major trauma exists, regardless of what excretory urography shows.     

Blunt urinary tract trauma: identifying those patients who require radiological diagnostic studies

We evaluated prospectively 506 consecutive patients who presented with a history of blunt trauma and hematuria. All patients initially underwent excretory urography and cystography. Of the 506 patients 25 had detectable urinary tract injuries that were confirmed either by the initial studies or by computerized tomography, angiography or direct intraoperative inspection. Diagnoses included 7 renal contusions, 7 renal lacerations (1 major and 6 minor), 1 renal artery, 3 intraperitoneal and 5 extraperitoneal bladder ruptures, and 2 urethral injuries. Of the 25 patients 21 presented with gross hematuria, including all of those with lower tract injuries. One of the 4 patients who presented with microhematuria was hospitalized in shock. Of the remaining 3 patients with microhematuria and no shock 1 had a minor renal laceration and 2 had renal contusions. All 3 patients were managed conservatively and all 3 were hospitalized chiefly for associated nonurological injuries. If the patients who presented with microhematuria and no shock were excluded from initial radiographic evaluation, 1 minor renal laceration and 2 renal contusions would have been missed. If we had added 1 more exclusion criterion, that of absence of major associated injuries, we would not have missed an injury.     

Selective surgical management of renal stab wounds.

Patients with stab wounds and haematuria were selected for surgical exploration if they had signs of severe blood loss, an associated intra-abdominal laceration or major abnormality on the intravenous urogram (IVU). Patients without these signs were selected for non-operative management, consisting of bed rest, an intravenous antibiotic for 24 h and regular observation. Of 95 patients, 60 (63%) were selected for non-operative management (Group 1) and 35 (37%) were selected for primary surgical exploration (Group 2). At surgery in Group 2, a major renal injury and/or associated intra-abdominal laceration was found in 31 patients. Thus a probably unnecessary operation was performed in only 4 patients (4% of the whole group of 95 patients). Renal complications occurred in 12 of the 60 patients (20%) in Group 1 and consisted mainly of secondary haemorrhage caused by an arteriovenous fistula (AVF) or pseudo-aneurysm. Management of the renal complications included segmental artery embolisation in 6, nephrectomy in 2, heminephrectomy in 1, open surgical ligation of an AVF in 1 and spontaneous resolution in 2 patients. The mean period of hospitalisation was significantly shorter in Group 1 (6.1 days) than in Group 2 patients (9.9 days). Comparing the Group 1 patients who developed renal complications with those who did not, we would recommend more aggressive selection for surgery of those patients exhibiting clinical signs of shock, a fall in haemoglobin during observation, a palpable abdominal mass, a haemothorax and/or pneumothorax ipsilateral to the renal injury, and IVU signs of extravasation, non-function, delayed excretion or hydroureteronephrosis due to blood clots.(ABSTRACT TRUNCATED AT 250 WORDS)     

Expectant management of blunt renal trauma

Summary Forty-two patients with blunt renal injuries were treated between 1984 and 1994 at our institution. Twenty-nine patients revealed a contusion (grade I injury), 10 showed lacerations (grade II), 1 a severe fracture (grade III), and 2 presented pedicle injuries (grade IV). All 10 patients with incomplete renal injuries (grade II) were treated conservatively, i. e. without primary surgery. One of these 10 patients required surgical intervention 3 months after the trauma due to a urinary obstruction. Two of the ten patients with grade II injuries suffered late complications, namely a contracted kidney in one case and hypertension in the other. This means that of 10 patients with conservatively treated grade II renal trauma, a loss of the function of the affected kidney occurred in only one. In 9 patients complete function of the kidney could be preserved. In conclusion, conservative management of incomplete blunt renal injuries is an effective treatment option with few complications.