The literature increasingly supports expectant (conservative) management of renal trauma--a systematic review.

BACKGROUND: The perfect degree of operative intervention in renal trauma is unknown. However, expectant management for most blunt renal trauma is the standard of care, and nonoperative management is increasingly accepted for stab wounds. The best treatment of gunshot wounds and vascular injuries is still unclear; however, recent data indicates that a trial of nonoperative therapy may be warranted in those not exsanguinating from the kidney. Conservative management has many benefits, the greatest of which is decreasing the rate of iatrogenic nephrectomy. We have reviewed the world's literature to determine the level of support for expectant management of renal injury.

METHODS: The English language literature concerning renal trauma was identified with the assistance of Medline, and additional cited works not picked up in the initial search were obtained. One hundred and ten citations were ultimately reviewed dating back to 1947.

RESULTS: Most modern citations support at least a trial of expectant management for renal trauma patients not exsanguinating from the kidney, and without ureteral or renal pelvis injuries. The treatment of renovascular injuries has less consensus, but it appears that 'conservative' management by the application of nephrectomy is often the best approach, although renovascular repair may be attempted in rare cases.

CONCLUSION: Dozens of papers going back as far as 50 years seem to support the wider use of nonoperative therapy of renal injuries, although for unclear reasons, this approach is not yet universally accepted.