Should the conservative management of renal trauma include bedrest and prolonged antibiotics?

Abstract text (incl. references and figure legends)

Introduction

Traumatic kidney injuries are the most common urological trauma. Traditionally, the non-operative management of renal trauma included bedrest and antibiotics, which are not advocated in other solid organ injuries. The purpose of this study was to review the management and outcomes of renal trauma at our major trauma centre including use of early mobilisation, selective antibiotics and low molecular weight heparin prophylaxis.

Materials and methods

This was a retrospective analysis of a prospectively maintained database at our London Major Trauma Centre. Adult patients with blunt and penetrating renal trauma, proven either on CT or operatively, presenting between January 2018 and September 2022 were included.

Results

120 patients were included for analysis: 74% with blunt renal trauma and 26% with penetrating renal trauma. 77% of patients presented with grade 3-5 injury. The vast majority of patients (92%) were permitted to mobilise within 24 hours, if other injuries allowed. Only 15 patients received antibiotics at urology request. 33% patients received prophylactic dose low molecular weight heparin within 48 hours of admission, with no adverse events seen on follow up imaging.

Conclusions

This data challenges established norms in the management of renal trauma. We believe that the management of renal trauma should follow that of other solid organ injury and our practice, supported by our outcomes, now includes early mobilisation, no antibiotic prophylaxis for blunt trauma, and early prophylactic low molecular weight heparin with early follow up CT and radiological intervention or ureteric stenting as required.

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