Isolated kidney injury: international recommendations and Moscow standards

Introduction. Currently, existing classifications of kidney injury severity do not indicate the choice of a particular treatment method. The purpose of our study was to retrospectively evaluate the management of patients with isolated kidney injury. Materials and methods. A retrospective analysis of the results of treatment of 52 patients with isolated kidney injury was performed. All patients according to the AAST (American Association for Surgery and Trauma) classification were divided into five groups: group I - 25 (48%) people, group II - 7 (13%), group III - 6 (12%), group IV - 11 (21%), group V - 3 (6%). Results. In patients with I degree of damage (n=25), no invasive methods of diagnosis and treatment were required: 12 (48%) patients were discharged from the hospital after active observation, 13 (52%) patients underwent complex conservative treatment. In group II (n=7), in most cases (n=6; 86%), treatment was also conservative, with the exception of one patient who underwent diagnostic angiography. All patients with grade III damage (n=6) underwent diagnostic angiography, and in 2 (33%) cases, selective embolization of the renal artery branch was performed. In group IV (n=11), diagnostic angiography was performed in 9 (82%) patients, however, selective embolization of the renal artery branch was effective in 7 (78%) patients, and the remaining 2 patients underwent organ-preserving surgery. Only 2 (18%) patients with grade IV damage had a nephrectomy. None of the patients with V degree of damage (n=3) could avoid nephrectomy. Discussion. Based on our own data and the results of foreign studies, it was concluded that the stability of hemodynamics is a fundamental sign of determining the tactics of treating a patient. In patients with stable hemodynamics with kidney injury, selective embolization of the branches of the renal artery is indicated. Angiography and embolization can be performed for kidney injuries of any degree, but it is most justified for complex injuries. The effectiveness of embolization is obvious, but unsuccessful embolization is a direct indication for renal revision. It should also be noted that open kidney injury is an absolute indication for revision. Conclusions. X-ray endovascular technologies are widely used in patients with isolated kidney injury, which in turn dictates the need to include this type of care in the standards of treatment of patients in this group.