CHOOSING THE BEST TREATMENT FOR GRADE IV RENAL INJURIES THAT ARE ISOLATED AND NOT ISOLATED.

Objective: The objective of this study was to review all grade IV renal injuries and report outcomes and ascertain whether operative and selective non-operative management could result in high salvage rates. Method: 150 grade IV kidney injuries that occurred at the Department of Urology, Rajendra Institute of Medical Science, Ranchi for one year. These were split into two groups: isolated grade IV renal injuries and nonrenal injuries and analyzed with regard to different categories. Salvage was defined as having a 50% or greater function of the injured kidney and an overall renal function of at least 20%. Results: Overall salvage rate of 83%, 105 patients were operated on and 45 were not. There were 80 injuries from penetrating trauma, 70 from blunt trauma, and 76 from renal vascular injury. There was a 14% nephrectomy rate and an 82% salvage rate for Grade IV renal injuries that required operative exploration and concurrently had linked injuries. 15 (41%) patients with isolated injuries required surgical exploration. Two kidneys were postoperatively nonfunctional, one moderate problem was discovered, and one patient required a nephrectomy. 10 patients needed transfusions, and 87% of the remaining 22 isolated grade IV renal injuries were handled nonoperatively. There was no need for delayed nephrectomy in the 45 nonoperative patients of solitary or nonisolated renal injury. Conclusion: Isolated grade IV renal injuries provide a special case where the patient must be treated purely based on the severity of the renal injury, nonoperative therapy is applied more frequently. Non-operative therapy should only be used in all cases of severe renal damage when patients are hemodynamically stable and have undergone full renal staging. Recommendation: It is crucial to understand the finest and most efficient treatment that may treat this condition with fewer complications for the patients because many patients experience Grade IV injuries.