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Open Access Research article

Late evaluation of the relationship between morphological and functional renal changes and hypertension after non-operative treatment of high-grade renal injuries

Gerson Alves Pereira Júnior125*, Valdair Francisco Muglia23, Antônio Carlos dos Santos23, Cecilia Hissae Miyake23, Fernando Nobre24, Mery Kato24, Marcus Vinicius Simões24 and José Ivan de Andrade12

Author Affiliations

1 Department of Surgery and Anatomy, Division of Trauma and Emergency Surgery, University of São Paulo, Sao Paulo, Brazil

2 Department of Internal Medicine, University of São Paulo, Sao Paulo, Brazil

3 Image and Medical Physics Center Division, University of São Paulo, Sao Paulo, Brazil

4 Cardiology Division; Faculty of Medicine of Ribeirão Preto, University of São Paulo, Sao Paulo, Brazil

5 Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto – USP, Unidade de Emergência, Centro de Estudos de Emergências em SaúdeRua Bernardino de Campos, 1000, CEP 14015-130 Ribeirão Preto, São Paulo, Brasil

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World Journal of Emergency Surgery 2012, 7:26  doi:10.1186/1749-7922-7-26

Published: 1 August 2012

Abstract

Objective

To evaluate the anatomical and functional renal alterations and the association with post-traumatic arterial hypertension.

Methods

The studied population included patients who sustained high grades renal injury (grades III to V) successfully non-operative management after staging by computed tomography over a 16-year period. Beyond the review of medical records, these patients were invited to the following protocol: clinical and laboratory evaluation, abdominal computed tomography, magnetic resonance angiography, DMSA renal scintigraphy, and ambulatory blood pressure monitoring. The hypertensive patients also were submitted to dynamic renal scintigraphy (99mTc EC), using captopril stimulation to verify renal vascular etiology.

Results

Of the 31 patients, there were thirteen grade III, sixteen grade IV (nine lacerations, and seven vascular lesions), and two grade V injuries. All the patients were asymptomatic and an average follow up post-injury of 6.4 years. None had abnormal BUN or seric creatinine. The percentage of renal volume reduction correlates with the severity as defined by OIS. There was no evidence of renal artery stenosis in Magnetic Resonance angiography (MRA). DMSA scanning demonstrated a decline in percentage of total renal function corresponding to injury severity (42.2 ± 5.5% for grade III, 35.3 ± 12.8% for grade IV, 13.5 ± 19.1 for grade V). Six patients (19.4%) had severe compromised function (< 30%). There was statistically significant difference in the decrease in renal function between parenchymal and vascular causes for grade IV injuries (p < 0.001). The 24-hour ambulatory blood pressure monitoring detected nine patients (29%) with post-traumatic hypertension. All the patients were male, mean 35.6 years, 77.8 % had a familial history of arterial hypertension, 66.7% had grade III renal injury, and average post-injury time was 7.8 years. Seven patients had negative captopril renography.

Conclusions

Late results of renal function after conservative treatment of high grades renal injuries are favorable, except for patients with grades IV with vascular injuries and grade V renal injuries. Moreover, arterial hypertension does not correlate with the grade of renal injury or reduction of renal function.

Keywords:
Renal injury; Conservative management; Follow-up imaging; Renal function; Radionuclide imaging; Dimercaptosuccinic acid; Computed tomography; Magnetic resonance angiography; Renal hypertension