AAST kidney injury scale

Renal trauma grading is often done using the American Association for the Surgery of Trauma (AAST) 3-4 according to depth of damage and involvement of the urinary collecting system and renal vessels.

Classification

  • grade I: contusion or non-enlarging subcapsular perirenal haematoma, and no laceration
  • grade II: superficial laceration <1 cm depth and does not involve the collecting system (no evidence of urine extravasation), non-expanding perirenal haematoma confined to retroperitoneum
  • grade III: laceration >1 cm without extension into the renal pelvis or collecting system (no evidence of urine extravasation)
  • grade IV
    • laceration extends to renal pelvis or urinary extravasation
    • vascular: injury to main renal artery or vein with contained haemorrhage
    • segmental infarctions without associated lacerations
    • expanding subcapsular haematomas compressing the kidney
  • grade V

NB: Advance one grade for multiple injuries up to grade III.

If a renal injury is seen on a routine portal phase CT of the abdomen, and there is no urine extravasation, a delayed series at 5-15 minutes should be considered to check for urine extravasation. This should not necessarily be performed if the patient is unstable or if there are other large, life-threatening injuries.

See also

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Article Information:

rID: 1972
Systems: Urogenital, Trauma
Section: Classifications
Synonyms or Alternate Spellings:
  • AAST grading of renal trauma
  • Renal trauma assessment
  • Renal trauma grade
  • Renal injury grading
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    Figure 1
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    Altered renal per...
    Case 1: grade I : right kidney
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    Figure 2
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    Case 2: grade II
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    Figure 3
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    Case 3: grade IV
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    Figure 4
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    Case 4: grade IV
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    Figure 5
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    Case 5: grade IV
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    Case 6: grade V : left kidney
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    Case 7: grade V : shattered kidney (+ splenic laceration)
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    Case 8: grade V + concurrent splenic injury
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    Case 9: grade V
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    Case 10: grade V
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