AAST kidney injury scale
Updates to Article Attributes
Body
was changed:
The 2018 update of the American Association for the Surgery of Trauma (AAST) renal injury scaleis the most widely used grading system for renal trauma at the time of writing (late 2018) 8. Severity is assessed according to the depth of renal parenchymal damage and involvement of the urinary collecting system and renal vessels.
Classification
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grade I:
- subcapsular haematoma or contusion, without laceration
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grade II:
- superficial laceration ≤1 cm depth not involving the collecting system (no evidence of urine extravasation)
- perirenal haematoma confined within the perirenal fascia
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grade III:
- laceration >1 cm not involving the collecting system (no evidence of urine extravasation)
- vascular injury or active bleeding confined within the perirenal fascia
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grade IV
- laceration involving the collecting system with urinary extravasation
- laceration of the renal pelvis and/or complete
uretopelvicureteropelvic disruption - vascular: injury to segmental renal artery or vein
- segmental infarctions without associated active bleeding (i.e. due to vessel thrombosis)
- active bleeding extending beyond the perirenal fascia (i.e. into the retroperitoneum or peritoneum)
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grade V
- shattered kidney
- avulsion of renal hilum or laceration of the main renal artery or vein: devascularisation of a kidney due to hilar injury
- devascularised kidney with active bleeding
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.
Treatment and prognosis
- grade I: Conservative management.
- grade II: Conservative management under close observation.
- grade III: Conservative management under close observation. Surgical management, if the patient is undergoing laparotomy for other abdominal injuries.
- grade IV: Surgical management, if the patient is undergoing laparotomy for other abdominal injuries.
- grade V: Surgical management.
Complications
- patients with Grade IV renal injury are at risk for developing hypertension due to a decrease in the renal blood flow, secondary to compression of the renal vessels, leading to an activation of the renin-angiotensin system - Page kidney.
See also
-<li>laceration of the renal pelvis and/or complete uretopelvic disruption</li>- +<li>laceration of the renal pelvis and/or complete ureteropelvic disruption</li>
-</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>- +</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>Treatment and prognosis</h4><ul>
- +<li>grade I: Conservative management.</li>
- +<li>grade II: Conservative management under close observation. </li>
- +<li>grade III: Conservative management under close observation. Surgical management, if the patient is undergoing laparotomy for other abdominal injuries. </li>
- +<li>grade IV: Surgical management, if the patient is undergoing laparotomy for other abdominal injuries. </li>
- +<li>grade V: Surgical management. </li>
- +</ul><h4>Complications</h4><ul><li>patients with Grade IV renal injury are at risk for developing hypertension due to a decrease in the renal blood flow, secondary to compression of the renal vessels, leading to an activation of the renin-angiotensin system - <a title="Page kidney" href="/articles/page-kidney">Page kidney</a>.</li></ul><h4>See also</h4><ul>
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