The role of angiography in diagnosis and management of blunt renal trauma.

In a series of 223 patients with blunt renal injury, 40 patients underwent angiography. From this experience the following conclusions have been drawn: If a renal injury is suspected the IVP must be done as soon as possible. In most cases the diagnosis can be confirmed. Mild injuries should be managed conservatively and therefore need no angiography. In life endangering injury there is no time for angiography. The operation should be done preferably by a transperitoneal approach to allow good control of the renal pedicle. Patients with severe injuries should undergo angiography. If there is no function on the IVP, angiography should be done immediately to diagnose possible arterial thrombosis. In most cases angiography can be carried out some days after the trauma. This investigation provides an exact diagnosis and helps in deciding about further treatment. If a major part of the kidney has no blood supply, or there is a rupture with a large perirenal extravasation of urine, we recommend conservative surgery to avoid early and late complications. All operations should be done some days after the trauma. All patients with renal injuries, either operated or conservatively managed, should be carefully followed up. Angiography should be done in all cases of post-traumatic hypertension.