Management algorithm for complete blunt renal artery occlusion in multiple trauma patients: Case series

Objective: To study the management of complete renal artery occlusion in multiple trauma patients so as to develop a management algorithm. Design: Retrospective study. Patients and methods: All blunt trauma patients who had complete renal artery occlusion and were treated at Tawam and Al-Ain Hospitals during 2005-2007 were studied. Results: There were five patients having a median age of 21 years and a median ISS of 34. Four were males and four had motor vehicle collisions. Three had the injury on the right side while two on the left side. Three patients were treated conservatively. The kidney was left in situ in one patient who underwent damage control laparotomy. An attempted renal artery repair was aborted due to haemo-dynamic instability in another patient. Patients were followed up for a median of 9 months and creatinine was normal in all patients. One patient developed hypertension and had interval nephrectomy. Conclusions: Conservative management is advised in the treatment of unilateral complete blunt renal artery thrombosis. These patients need close follow-up for the risk of hypertension. Blunt renal artery thrombosis in multiple trauma patients indicates severe injury. Surgeons should critically assess the added risk of mortality against chances of recovering the renal function.