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Grade 4 Renal Trauma


  • Noncontrast CT demonstrated large subcapsular hematoma and laceration through the kidney. There is a subtle contrast difference between the kidney and the areas of hemorrhage.
  • Contrast CT demonstrated lack of perfusion of most of the lower and mid portions of the right kidney. There are areas of contrast extravasation.


Renal trauma is graded according to the American Association for the Surgery of Trauma.

Renal Trauma Grading

  • Grade I
    • Subcapsular contusion
  • Grade II
    • Nonexpanding perirenal hematoma confined to retroperitoneum or laceration < 1cm
  • Grade III
    • Laceration > 1cm parenchymal depth without collecting system rupture
  • Grade IV
    • Laceration extending through renal cortex, medulla and collecting system. Main renal artery or vein injury with contained hemorrhage
  • Grade V
    • Completely shattered kidney
    • Avulsioin of renal hilum

How Would You Treat This?

A. Nephrectomy
B. Partial Nephrectomy
C. Fluid resuscitation including transfusion
D. Embolization