Preserving the Injured Kidney: A Retrospective Comparative Cohort Study of Contemporary Management Strategies at a Level 1 Trauma Center

PURPOSE: To evaluate and compare renal injury patterns, management pathways, clinical outcomes, and renal function following renal trauma at a high-volume Level 1 trauma center. MATERIALS AND METHODS: A single-center retrospective cohort study was performed. Patients aged ≥16 years with renal trauma over a 12-year period were included. Data collected included injury mechanism, injury grade, hemodynamic status, and renal function. Primary management was classified as conservative, interventional radiology (IR; embolization), and surgery. Outcomes included nephrectomy, 30-day mortality, and postdischarge renal function. Subgroup analyses were performed for hemodynamically unstable, high-grade injuries and embolization patient groups. RESULTS: A total of 573 patients were included (median age, 37 years [interquartile range, 24-54 years]; 82% men); 537 patients (94%) were primarily managed conservatively, while 25 (4%) underwent primary embolization and 11 (1.7%) primary surgery. Nephrectomy was performed in 4 patients (0.7%). Thirty-day all-cause mortality was 2.3%, with renal trauma-specific mortality of 0.2%. Among hemodynamically unstable (n = 123) and high-grade injuries (n = 181) subgroups, conservative management was predominant with similar outcomes. Embolization demonstrated 100% technical success, was mostly selective or superselective (88%), and resulted in low subsequent nephrectomy rate (3%). Renal function outcomes were encouraging among patients with available data, although interpretation was limited by capped eGFR reporting and incomplete follow-up. CONCLUSIONS: Renal trauma is safely and effectively managed conservatively when clinically appropriate, including in patients with initial hemodynamic instability and high-grade injuries. Embolization provides a definitive, organ-sparing escalation strategy for ongoing hemorrhage, with encouraging renal function outcomes among patients with available data.