Department of Surgery and Anatomy, Division of Trauma and Emergency Surgery, University of São Paulo, Sao Paulo, Brazil.
World J Emerg Surg. 2012 Aug 1;7(1):26. doi: 10.1186/1749-7922-7-26.
To evaluate the anatomical and functional renal alterations and the association with post-traumatic arterial hypertension.
The studied population included patients who sustained high grades renal injury (grades III to V) successfully non-operative management after staging by computed tomography over a 16-year period. Beyond the review of medical records, these patients were invited to the following protocol: clinical and laboratory evaluation, abdominal computed tomography, magnetic resonance angiography, DMSA renal scintigraphy, and ambulatory blood pressure monitoring. The hypertensive patients also were submitted to dynamic renal scintigraphy (99mTc EC), using captopril stimulation to verify renal vascular etiology.
Of the 31 patients, there were thirteen grade III, sixteen grade IV (nine lacerations, and seven vascular lesions), and two grade V injuries. All the patients were asymptomatic and an average follow up post-injury of 6.4 years. None had abnormal BUN or seric creatinine. The percentage of renal volume reduction correlates with the severity as defined by OIS. There was no evidence of renal artery stenosis in Magnetic Resonance angiography (MRA). DMSA scanning demonstrated a decline in percentage of total renal function corresponding to injury severity (42.2 ± 5.5% for grade III, 35.3 ± 12.8% for grade IV, 13.5 ± 19.1 for grade V). Six patients (19.4%) had severe compromised function (< 30%). There was statistically significant difference in the decrease in renal function between parenchymal and vascular causes for grade IV injuries (p < 0.001). The 24-hour ambulatory blood pressure monitoring detected nine patients (29%) with post-traumatic hypertension. All the patients were male, mean 35.6 years, 77.8 % had a familial history of arterial hypertension, 66.7% had grade III renal injury, and average post-injury time was 7.8 years. Seven patients had negative captopril renography.
Late results of renal function after conservative treatment of high grades renal injuries are favorable, except for patients with grades IV with vascular injuries and grade V renal injuries. Moreover, arterial hypertension does not correlate with the grade of renal injury or reduction of renal function.
评估解剖和功能肾改变，并与创伤后动脉高血压相关联。
研究人群包括在 16 年期间通过计算机断层扫描分期成功接受非手术治疗的高等级肾损伤（等级 III 至 V）患者。除了病历审查外，还邀请这些患者参加以下方案：临床和实验室评估、腹部计算机断层扫描、磁共振血管造影、DMSA 肾闪烁显像和动态血压监测。高血压患者还接受了动态肾闪烁显像（99mTc EC），使用卡托普利刺激来验证肾血管病因。
31 例患者中，有 13 例为 III 级，16 例为 IV 级（9 例为撕裂伤，7 例为血管病变），2 例为 V 级损伤。所有患者均无症状，伤后平均随访时间为 6.4 年。BUN 或血清肌酐均无异常。肾体积减少的百分比与 OIS 定义的严重程度相关。磁共振血管造影（MRA）无肾动脉狭窄证据。DMSA 扫描显示，总肾功能百分比与损伤严重程度呈下降趋势（III 级为 42.2±5.5%，IV 级为 35.3±12.8%，V 级为 13.5±19.1%）。6 例（19.4%）患者严重肾功能受损（<30%）。IV 级损伤中，实质和血管病因引起的肾功能下降有统计学显著差异（p<0.001）。24 小时动态血压监测发现 9 例（29%）患者有创伤后高血压。所有患者均为男性，平均年龄 35.6 岁，77.8%有家族性动脉高血压史，66.7%为 III 级肾损伤，平均伤后时间为 7.8 年。7 例患者卡托普利肾图检查结果为阴性。
高等级肾损伤保守治疗后的肾功能晚期结果良好，除了 IV 级伴血管损伤和 V 级肾损伤患者。此外，动脉高血压与肾损伤程度或肾功能下降无关。
