Nephrectomy does not elevate risk of death, AKI after high-grade renal trauma

Undergoing nephrectomy after high-grade renal trauma (HGRT) does not appear to increase mortality or acute kidney injury (AKI) following adjustments for volume of blood transfused in the first 24 hours, a recent study has shown.

“As a clinical principle, trauma nephrectomy should be avoided when possible,” the authors said.

It was previously thought that patients with HGRT undergoing nephrectomy could be at greater risk for death than those treated conservatively, but no study had controlled for degree of haemorrhage as a measure of shock.

To address this, the authors identified patients with HGRT (American Association for the Surgery of Trauma grade III–V) in Trauma Quality Improvement Program (2013–2017) and adjusted for the probability of nephrectomy using propensity scoring.

The association of nephrectomy with mortality and AKI was analysed using conditional logistic regression, with adjustments for patient characteristics, injury specifics, and physiological factors including blood transfusions.

A total of 12,780 patients with HGRT were identified, of whom 1,014 (7.9 percent) underwent nephrectomy. Mortality was 10.6 percent in the nephrectomy group and 4.2 percent in the non-nephrectomy group (p<0.001). In addition, more patients who went through nephrectomy experienced AKI (8.6 percent vs 2.4 percent; p<0.001).

However, nephrectomy was neither associated with mortality (odds ratio, 0.367, 95 percent confidence interval, 0.09‒1.497; p=0.162) nor with AKI in the adjusted analysis.

Notably, the following factors correlated with higher mortality: increasing age, non-Caucasian race, increasing Injury Severity Score, decreasing Glasgow Coma Score, and blood transfusions. On the other hand, AKI correlated independently with male sex, increasing age, and blood transfusions.