The AAST (American Association for the Surgery of Trauma) renal injury scale 3-4 is the most widely used renal trauma grading system at the time of writing (mid 2016). Severity is assessed according to the depth of renal parenchymal damage and involvement of the urinary collecting system and renal vessels.
- 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)
- 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 phase 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.
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