AAST kidney injury scale

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The American Association for the Surgery of Trauma (AAST) renal injury scale ^3-41,6 is the most widely used grading system for renal trauma at the time of writing (late 2016). Severity is assessed according to the depth of renal parenchymal 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
- shattered kidney
- avulsion of renal hilum: devascularisation of a kidney due to hilar injury
- ureteropelvic avulsions
- complete laceration or thrombus of the main renal artery or vein

NB. advance one grade for bilateral injuries up to grade III.

If a renal injury is detected on a routine trauma portal venous phase CT of the abdomen without evidence of urine extravasation, then a delayed phase at 5-15 minutes should be considered to assess for urine extravasation, especially if there are clinical signs of collecting system injury (e.g. haematuria or blood at the meatus)⁵. This should not necessarily be performed if the patient is unstable or if there are other large, life-threatening injuries.

-<p>The <strong>American Association for the Surgery of Trauma (AAST)</strong> <strong>renal injury scale </strong><sup>3-4 </sup> is the most widely used grading system for <a href="/articles/renal-trauma-1">renal trauma</a> at the time of writing (late 2016). Severity is assessed according to the depth of renal parenchymal damage and involvement of the urinary collecting system and renal vessels.</p><h4>Classification</h4><ul>
+<p>The <strong>American Association for the Surgery of Trauma (AAST)</strong> <strong>renal injury scale </strong><sup>1,6 </sup> is the most widely used grading system for <a href="/articles/renal-trauma-1">renal trauma</a> at the time of writing (late 2016). Severity is assessed according to the depth of renal parenchymal damage and involvement of the urinary collecting system and renal vessels.</p><h4>Classification</h4><ul>
-</ul><p>NB. advance one grade for bilateral injuries up to grade III.</p><p>If a renal injury is detected on a routine trauma portal venous phase CT of the abdomen without evidence of urine extravasation, then a delayed phase at 5-15 minutes should be considered to assess for urine extravasation, especially if there are clinical signs of collecting system injury (e.g. haematuria or blood at the meatus). This should not necessarily be performed if the patient is unstable or if there are other large, life-threatening injuries.</p><h4>See also</h4><ul>
+</ul><p>NB. advance one grade for bilateral injuries up to grade III.</p><p>If a renal injury is detected on a routine trauma portal venous phase CT of the abdomen without evidence of urine extravasation, then a delayed phase at 5-15 minutes should be considered to assess for urine extravasation, especially if there are clinical signs of collecting system injury (e.g. haematuria or blood at the meatus) <sup>5</sup>. This should not necessarily be performed if the patient is unstable or if there are other large, life-threatening injuries.</p><h4>See also</h4><ul>

References changed:

1. Moore E, Shackford S, Pachter H et al. Organ Injury Scaling: Spleen, Liver, and Kidney. J Trauma. 1989;29(12):1664-6. - <a href="https://www.ncbi.nlm.nih.gov/pubmed/2593197">Pubmed</a>
2. Kawashima A, Sandler C, Corl F et al. Imaging of Renal Trauma: A Comprehensive Review. Radiographics. 2001;21(3):557-74. <a href="https://doi.org/10.1148/radiographics.21.3.g01ma11557">doi:10.1148/radiographics.21.3.g01ma11557</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/11353106">Pubmed</a>
3. Smith J & Kenney P. Imaging of Renal Trauma. Radiol Clin North Am. 2003;41(5):1019-35. <a href="https://doi.org/10.1016/s0033-8389(03)00075-7">doi:10.1016/s0033-8389(03)00075-7</a>
4. Park S, Kim J, Kim K, Cho K. MDCT Findings of Renal Trauma. AJR Am J Roentgenol. 2006;187(2):541-7. <a href="https://doi.org/10.2214/ajr.05.0543">doi:10.2214/ajr.05.0543</a>
5. Stuhlfaut J, Lucey B, Varghese J, Soto J. Blunt Abdominal Trauma: Utility of 5-Minute Delayed CT with a Reduced Radiation Dose. Radiology. 2006;238(2):473-9. <a href="https://doi.org/10.1148/radiol.2382042096">doi:10.1148/radiol.2382042096</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/16436812">Pubmed</a>
6. Ramchandani P & Buckler P. Imaging of Genitourinary Trauma. AJR Am J Roentgenol. 2009;192(6):1514-23. <a href="https://doi.org/10.2214/ajr.09.2470">doi:10.2214/ajr.09.2470</a>
7. Srinivasa R, Akbar S, Jafri S, Howells G. Genitourinary Trauma: A Pictorial Essay. Emerg Radiol. 2009;16(1):21-33. <a href="https://doi.org/10.1007/s10140-008-0738-x">doi:10.1007/s10140-008-0738-x</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/18548297">Pubmed</a>
7. http://www.aast.org/library/traumatools/injuryscoringscales.aspx
1. Kawashima A, Sandler CM, Corl FM et-al. Imaging of renal trauma: a comprehensive review. Radiographics. 21 (3): 557-74. <a href="http://radiographics.rsna.org/content/21/3/557.full">Radiographics (full text)</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/11353106">Pubmed citation</a><div class="ref_v2"></div>
2. Park SJ, Kim JK, Kim KW et-al. MDCT Findings of renal trauma. AJR Am J Roentgenol. 2006;187 (2): 541-7. <a href="http://dx.doi.org/10.2214/AJR.05.0543">doi:10.2214/AJR.05.0543</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/16861561">Pubmed citation</a><div class="ref_v2"></div>
3. Moore EE, Shackford SR, Pachter HL et-al. Organ injury scaling: spleen, liver, and kidney. J Trauma. 1989;29 (12): 1664-6. - <a href="http://www.ncbi.nlm.nih.gov/pubmed/2593197">Pubmed citation</a><div class="ref_v2"></div>
4. Ramchandani P, Buckler PM. Imaging of genitourinary trauma. AJR Am J Roentgenol. 2009;192 (6): 1514-23. <a href="http://dx.doi.org/10.2214/AJR.09.2470">doi:10.2214/AJR.09.2470</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/19457813">Pubmed citation</a><div class="ref_v2"></div>
5. Srinivasa RN, Akbar SA, Jafri SZ et-al. Genitourinary trauma: a pictorial essay. Emerg Radiol. 2009;16 (1): 21-33. <a href="http://dx.doi.org/10.1007/s10140-008-0738-x">doi:10.1007/s10140-008-0738-x</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/18548297">Pubmed citation</a><div class="ref_v2"></div>
6. Smith J, Kenney P. Radiologic Clinics of North America. 2003;41 (5): . <a href="http://dx.doi.org/10.1016/S0033-8389(03)00075-7">doi:10.1016/S0033-8389(03)00075-7</a><span class="auto"></span>

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AAST kidney injury scale

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