What classification is appropriate in renal trauma?

OBJECTIVE

The objective of this paper is to attain an adequate consideration of the relevant factors in conventional classifications of renal trauma and to work out a differentiated classification with a simple trauma formula suitable for both scientific purposes and for clinical decision-making.

METHOD

Previous classifications of renal trauma were evaluated retrospectively to establish whether and to what extent all criteria have been considered which may be important for the outcome of kidney trauma. The pathogenesis, the locations and the symptoms of the injuries with their degrees served as principal parameters.

RESULTS

From 1950 to 1991, a minimum of 24 classifications of renal trauma with different criteria has been used. In 54.2% of these, blunt and perforating injuries were not distinguished. Injuries of the renal pelvis or the vascular system were not considered in 62.9 and 8.3% of these, respectively. The degrees of severity ranged from 2 to 6 (on average, 3.5). In 87.5%, there was a combination with the injury location (renal pelvis, vascular system). Finally, of 29 definable criteria, an average of only 9.6 was specified, i.e. most were not evaluated at all.

CONCLUSION

It is concluded that most of the previous classifications of renal trauma neither clearly distinguish between nor adequately differentiate their individual factors. This may be a major reason for the persistence of controversies with regard to concepts of therapy, since they are based on inadequate definitions of comparative studies. A more differentiated PLS classification is proposed comprising the following elements: the pathogenesis P1 (blunt injuries), P2 (perforating injuries), the locations of the injuries LA (parenchyma), LB (renal pelvis), LC (vascular system) with their degrees of injury LA 0-7, LB 0-2, LC 0-9, and the symptoms of injury SA (hemorrhage), SB (extravasation of urine), SC (kidney damage) with their degrees of severity SA 0-3, SB 0-3, SC 0-3 as prognostic factors. The new classification incorporated in a simple trauma formula may enable more precise scientific investigation and also facilitate clinical decisions, so that patients with kidney trauma can be treated more specifically.