Ctrl

K

Table of contents

Expand All Topics

Kidney trauma

What's new

The European Society for Vascular Surgery (ESVS) has released new guidelines for the management of vascular trauma, including renal artery injury. Revascularization is not recommended for a devascularized unilateral kidney on CTA (ESVS grade 1 or X). For ESVS grade 2 injuries (e.g., pseudoaneurysm), endovascular stent graft repair is suggested. For ESVS grade 3 injuries, open or endovascular renal artery repair is suggested in hemodynamically stable patients, while renal artery ligation, with or without simultaneous nephrectomy, is recommended in hemodynamically unstable patients. For bilateral injuries (ESVS grade 2, 3, or X) or a solitary salvageable kidney, open or endovascular renal artery repair is recommended. .

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of kidney trauma are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2025), the European Society for Vascular Surgery (ESVS 2025), the Eastern Association for the Surgery of Trauma (EAST 2023,2019), the Society of Interventional Radiology (SIR 2020), the World Society of Emergency Surgery ...
Show more

Diagnostic investigations

Clinical assessment
As per EAU 2025 guidelines:
Assess hemodynamic stability upon admission of patients with suspected kidney trauma.
A
Record past renal surgery, and known preexisting renal abnormalities (ureteropelvic junction obstruction, solitary kidney, kidney stone disease).
A
Create free account

More topics in this section

  • Urinalysis

  • Ultrasound

  • CT

  • Intravenous urography

Medical management

Nonoperative management: as per EAU 2025 guidelines, offer nonoperative management with close monitoring and repeat imaging as required in stable patients with blunt kidney trauma.
A
Show 2 more
Create free account

Therapeutic procedures

Angioembolization: as per EAU 2025 guidelines, perform selective angioembolization for active renal bleeding if there are no other indications for immediate surgical exploration.
A
Create free account

More topics in this section

  • Endovascular balloon occlusion of the renal artery

  • REBOA

Surgical interventions

Indications for surgery: as per EAU 2025 guidelines, perform renal exploration in the presence of persistent hemodynamic instability due to renal injury after failure of nonoperative management.
A
Show 2 more
Create free account

Specific circumstances

Pediatric patients: as per AAST/WSES 2019 guidelines, obtain contrast-enhanced CT with delayed urographic phase as the gold standard in severely injured pediatric patients with suspected kidney or urinary tract injury.
A
Show 5 more
Create free account

More topics in this section

  • Patients with renal artery injury

  • Patients with ureteral injury

  • Patients with bladder injury

  • Patients with urethral injury

Follow-up and surveillance

Imaging follow-up: as per EAU 2025 guidelines, repeat imaging in high-grade and penetrating injuries and in cases of fever, worsening flank pain, or falling hematocrit.
A
Create free account

More topics in this section

  • Return to sport activities

  • Long-term follow-up