Accurate assessrment of severity and degree of renal injuries is required because their management is different according to the extent of rellal damage. Recently the diagnostic accuracy of determining the severity of renal injury is relatively high, which enables the physician to determine the selection of treatment modality more easily and enhance the possibility of renal preservation. Between 1972 and 1989, a total of 109 patients with renal injury admitted to Department of Urology, Hanyang University Hospital were evaluated to determine the diagnostic accuracy of radiologic studies. There were 87 males and 22 females.
The various causes of trauma were traffic accidents (41 patients), falls (36 patients), blow or kick injuries (27 patients), stab injuries (5 patients). Types of renal injuries were contusion (55%), minor injuries (15%), major injuries (26%) and vascular injuries (4%). Associated injuries were present in 45% of the patients and bone fracture (39 patients) was the most common injury.
Drip infusion pyelography or intravenous pyelography were underwent in 82 patients, which showed the accuracy of 59% to assess the severity and degree of the renal injury, However the accuracy of the ultrasonography for 21 patients were 71%, and 100%, for angiography (18 patients), 100% for computed tomography (14 patients), respectively. Nephrectomy was underwent for 19 patients, renorrhaphy for 5 patients and partial nephrectomy for 2 patients.
As mentioned above, excretory urography miaht not fully establish the degree and extent of renal injury, thus next diagnostic methods were needed in many cases. Although angiography proved the accuracy of the renal injury, it is moderately invasive and not required to perform foi all patient with renal injury. Computed tomography has provided the clearest morphologic information, both the extent of injury and the vasculariEation of the injured part of the kidney. Computed tomograplly scanning has resulted in a decrease in the use of angiography for diagnosis of renal injury.
These results suggest that computed tomography is the mosr effective initial dianostic methord for staging renal injury and the acculrate staging with computed
tomography will provide the appropriate management and reduce the renal loss.
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