• Rigoberto Pallares-Mendez, Daniel Eduardo Cervantes-Miranda, Evelyn Susana Castillo-Godinez, Carlos de la Cruz-de la Cruz, Marco Antonio Aguilar-Méndez, Adrian Gutierrez-Gonzalez, Fernando Mendoza-Castillo, Héctor Mata-Torres, Mario Ochoa-Arvizo, Fred Montelongo-Rodriguez, Katherine Lyn Hernandez-Aranda, and Jesús Arturo Cota-Agüero.
• Department of Urology, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez". Universidad Autonoma de Nuevo Leon, Av. Madero y Gonzalitos S/N, Mitras Centro, C.P. 64460, Monterrey, Mexico. rigo_pallares@hotmail.com.
• Eur J Trauma Emerg Surg. 2023 Oct 1; 49 (5): 224122482241-2248.

PurposeTo evaluate predictive and associated risk factors for nephrectomy in renal trauma and assess a 6-point score for surgical decision-making.Patients And MethodsThis multicenter, retrospective, and observational study assessed 247 subjects with blunt or penetrating kidney trauma. Kidney injuries were classified according to the American Association for the Surgery of Trauma (AAST) Injury Scoring Scale. Renal trauma was classified as "low-grade" (Grades I-III), Grade IV, and Grade V. Subjects were compared according to conservative treatment (CTrt.) or nephrectomy. Predictive factors were evaluated with a multiple regression model. A 6-point score was evaluated with a ROC analysis.ResultsPatients requiring nephrectomy had a lower mean arterial pressure MAP compared to CTrt, 64.71 mmHg (SD ± 10.26) and 73.86 (SD ± 12.42), respectively (p =  < 0.001). A response to IV solutions was observed in 90.2% of patients undergoing CTrt. (p =  < 0.001, OR = 0.211, 95%CI = 0.101-0.442). Blood lactate ≥ 4 mmol/L was associated with nephrectomy (p =  < 0.001). A hematoma ≥ 25 mm was observed in 41.5% of patients undergoing nephrectomy compared to 20.1% of CTrt. (p = 0.004, OR = 9.29, 95% CI = 1.37-5.58). A logistic regression analysis (p =  < 0.001) showed that blood lactate ≥ 4 mmol/L (p = 0.043), an inadequate response to IV solutions (p = 0.041) and renal trauma grade IV-V (p =  < 0.001), predicted nephrectomy. A 6-point score with a cut-off value ≥ 3 points showed 83% sensitivity and 87% specificity for nephrectomy with an AUC of 89.9% (p =  < 0.001).ConclusionsAn inadequate response to IV solutions, a lactate level ≥ 4 mmol/L, and grade IV-V renal trauma predict nephrectomy. A score ≥ 3 points showed a good performance in this population.© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

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