The effects of treatment of renal trauma on renal function.

Renal function studies were performed in 275 severely injured patients with hemorrhagic shock and massive transfusion. There were 230 patients without renal injury and 45 patients with renal injury treated without exploration of the kidney in 17 patients, with exploration and renorrhaphy in nine patients, and with partial or total nephrectomy in 19 patients. In addition, 45 patients without renal injury were randomly matched by computer to the 45 patients with renal injury based on the number of blood transfusions and severity of shock as indicators of physiologic insult. Renal function was adversely affected by partial or total nephrectomy in patients with renal injury. Significant decreases in renal filtration and excretion were seen when the nephrectomy group was compared to the patients without renal injury matched for injury insult. Creatinine clearance decreased from 103 ml/min to 55 ml/min, inulin clearance from 106 ml/min to 63 ml/min, and osmolar clearance from 4.8 ml/min to 3.3 ml/min. The 230 patients without renal injury had an incidence of renal failure of 7.4% and a mortality rate of 8.2% compared to 11.4% and 15.6%, respectively, in the 45 patients with renal injury. Death and renal failure occurred in 13 of the 230 patients without renal injury (5.6%) and in two of the 45 renal injury patients (4.4%). The incidence of renal failure in the 19 patients without renal injury who died was 68% versus 29% in the seven renal injury patients who died. Preservation of renal parenchyma is recommended to provide maximal renal function in severely injured patients.