Long-Term Follow-up after Kidney Trauma at Prof. Dr. R. D. Kandou General Hospital Manado

e-CliniC 2025; Vol. 13, No. 2: 171-176 DOI: https://doi.org/10.35790/ecl.v13i2.59605 URL Homepage: https://ejournal.unsrat.ac.id/index.php/eclinic Long-Term Follow-up after Kidney Trauma at Prof. Dr. R. D. Kandou General Hospital Manado Eko Arianto,1 Bryan P. Panelewen,2 Ari Astram,1 Christof Toreh,1 Frendy Wihono1 1 Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sam Ratulangi, Manado, Indonesia 2 Department of Surgery, Faculty of Medicine, Universitas Sam Ratulangi, Manado, Indonesia Email: Received: December 23, 2024; Accepted: March 11, 2025; Published online: March 13, 2025 Abstract: Renal trauma, caused by blunt or penetrating injuries, is associated with severe complications such as hypertension, chronic kidney disease (CKD), and pyelonephritis, especially in high-grade renal trauma. The study aimed to evaluate the complications and management of renal trauma patients at Prof. Dr. R. D. Kandou Hospital Manado from January 2022 to October 2024. This was an observational study with a cross-sectional design involving 17 patients that met the inclusion criteria. Data included types of trauma, severity level, management approaches, and post-trauma complications. Trauma severity was classified using the American Association for Surgery of Trauma (AAST) grading system. The results showed that 58.8% of patients had penetrating trauma, while 41.2% experienced blunt trauma. The highest percentages were found in grade II severity (29.4%). Operative management was the most common approach (58.8%). Post-trauma complications included CKD (70.5%), hypertension (29.4%), and pyelonephritis (29.4%). In conclusion, renal trauma, whether blunt or penetrating, often leads to significant complications such as CKD and hypertension. Proper long-term management and monitoring of kidney function and blood pressure are crucial to minimize the complications. This study highlights the need for early and effective intervention in high-grade renal trauma cases. Keywords: renal trauma; hypertension; acute kidney injury (AKI); chronic kidney disease (CKD); post-trauma complications 171 172 e-CliniC, Volume 13, Nomor 2, 2025, hlm. 171-176 INTRODUCTION Renal trauma is an injury to the kidney caused by blunt force trauma or penetrating injuries such as stab or gunshot wounds.1 Renal trauma can damage the renal parenchyma or vascularization, leading to bleeding or injury in the collecting system. Renal trauma accounts for 5% of all trauma cases, predominantly occurring in young males (72–93% of cases) with an average age of 31–38 years. The incidence is higher in penetrating trauma, with an average age of 27–28 years. Renal trauma can occur in isolation, but 80–95% of cases are accompanied by other injuries.2 Early complications of renal trauma include bleeding, infection, perinephric abscess, sepsis, urinary fistula, hypertension, urine extravasation, urinoma, and rhabdomyolysis, whereas delayed complications include stone formation, chronic pyelonephritis, hypertension, arteriovenous fistula, pseudoaneurysm, and hypertension. Common complications in non-operative management of high-grade renal trauma include hematuria, Acute Kidney Injury (AKI), and urinoma. In contrast, complications in operative management include wound infection, perinephric abscess, and urinary tract infections.3 Rhabdomyolysis, which is the breakdown and rupture of muscle fibers, results in the release of muscle cell contents, including the protein myoglobin, into the bloodstream. This condition, caused by ischemia associated with vascular injury or systemic hypoperfusion, increases the risk of AKI.4 The incidence of post-trauma AKI ranges from 0.1% to 8.4% in various studies, with a mortality rate of 7–83%. Patients are at higher risk of developing chronic kidney disease (CKD) later. Impaired kidney function post-trauma indicates vascular damage, demonstrated by decreased renal function. Impaired renal function, duration, and severity of post-trauma AKI contribute to maladaptive repair, characterized by permanent kidney dysfunction accompanied by significant structural changes. Close follow-up of injured patients and use of imaging, including computed tomography scan, arteriogram, or retro-grade pyelogram when appropriate, increase detection rates and establish the diagnosis in most patients. Treatment varies by etiology and may range from watchful waiting to percutaneous drainage, and in rare cases, nephrectomy.5 The aim of this study is to evaluate the complications that occur in patients with renal trauma at RSUP Prof. Dr. R. D. Kandou Manado, as well as the management approaches employed in their treatment, covering the period from January 2022 to October 2024. This research seeks to provide a comprehensive understanding of the types of complications commonly encountered in patients with kidney injuries, as well as the diagnostic and therapeutic methods applied at the hospital. This research aims to assist healthcare professionals in developing more effective management strategies to reduce the risk of complications and enhance patient outcomes in cases of renal trauma. METHODS This was an observational cross-sectional study to evaluate blood pressure and serum ureacreatinine level in renal trauma cases at Prof. Dr. R. D. Kandou Hospital. The study analyzed medical records of renal trauma patients from January 2022 to October 2024. Renal trauma patients admitted to the Emergency Surgical Unit (IRDB) at Prof. Dr. R. D. Kandou Hospital were included based on the following criteria: renal trauma without other injuries, aged over 18 years, and inpatient treatment at Prof. Dr. R. D. Kandou Hospital. Exclusion criteria included patients with other trauma, a history of hypertension, pre-existing impaired kidney function, critical illnesses, or missing urea-creatinine data. Data were obtained from medical records of serum urea and creatinine levels and blood pressure measurements upon the first assessment of post-renal trauma. Renal trauma was classified using the American Association for Surgery of Trauma (AAST) injury scale, divided into grade IV.1 Blood pressure was measured using a mercury sphygmomanometer at least twice in a supine position and once in an upright position. Glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease (MDRD) formula: GFR = 175 × (Serum Creatinine) − 1.154 Arianto et al: Long-term follow-up after kidney trauma 173 × (Age) − 0.203 × (0.742 if female) × (1.212 if African American).6 Acute kidney injury (AKI) is defined according to the Clinical Practice Guidelines of The Kidney Disease: Improving Global Outcomes (KDIGO) as one of the following: an increase in serum creatinine by ≥0.3 mg/dL within 48 hours; or an increase in serum creatinine to ≥1.5 times the baseline, known or presumed to have occurred within the previous seven days; or urine output <0.5 mL/kg/hour for 6 hours.7 RESULTS Table 1 showed that a total of 17 (...truncated)