Most Read Articles
Roshini Claire Anthony, 4 days ago

The combined use of piperacillin and tazobactam does not appear to be a suitable alternative to meropenem for patients with bloodstream infections caused by ceftriaxone-resistant Escherichia coli (E. coli) or Klebsiella pneumoniae (K. pneumoniae), according to results of the MERINO* trial.

Tristan Manalac, 19 May 2018
Taking oral antibiotics appears to increase the risk of nephrolithiasis, according to a recent study. Moreover, the risk seems to be compounded for individuals with recent antibiotic exposure and those who were exposed at a younger age.
2 days ago
Patients with inflammatory bowel disease are at increased risk of developing acute myocardial infarction (AMI) or heart failure, although the prevalence of traditional risk factors for such cardiovascular disorders appears to be low, as reported in a recent study.
3 days ago
Early renin-angiotensin-aldosterone system (RAAS) blockade with renin-angiotensin system inhibitors (RASI) leads to better short- and long-term renal outcomes in systemic lupus erythematosus (SLE) patients with antiphospholipid-associated nephropathy (aPLN), according to a study, adding that this renal protective effect is independent of RASI’s antihypertensive and antiproteinuric effects.

Conservative management trumps early urinary tract drainage in non-penetrating renal trauma

Roshini Claire Anthony
20 Apr 2018

Conservative management appears to be the favoured option in managing non-penetrating renal trauma with urinary extravasation, according to a study presented at EAU 2018.

“Conservative management was associated with good outcomes as 83 percent of the patients didn’t require any drainage of their upper [urinary] tract and the urinary extravasation at repeat [computed tomography (CT) scan] was still present for 36 percent of the patients only,” said Dr Ala Chebbi from the CHU Hôpitaux de Rouen in Rouen, France who presented the findings.

This retrospective study was conducted in 17 centres in France between 2005 and 2015. Of the 1,800 patients who had renal trauma, 268 patients met the inclusion criteria (ie, urinary extravasation at their initial CT scan). Patients who had undergone a nephrectomy, were haemodynamically unstable, or who had penetrating renal trauma were excluded.

Patients were divided into two groups based on whether they had undergone early upper urinary tract drainage of the injured kidney with ureteric stent insertion (within 48 hours of admission; n=69, mean age 32 years, 78 percent male) or conservative management (observation; n=199, mean age 25 years, 79 percent male) following non-penetrating renal trauma.

Based on a repeat CT scan carried out after a mean 6 days, the incidence of persistent urinary extravasation at repeat CT was comparable between patients who had undergone early upper urinary tract drainage and conservative management (28 percent vs 36 percent; p=0.47). [EAU 2018, abstract 127]

This persistent leak led to a delayed upper urinary tract drainage with ureteric stent insertion in 17 percent of patients who initially underwent conservative management, while 3 percent of patients who initially underwent drainage required a repeat drainage (p=0.04).

Patients who underwent early upper urinary tract drainage had a longer length of hospitalization compared with those who underwent conservative management (mean, 21 vs 14 days; p=0.03). Incidence of complications and trauma-related death was comparable between the two groups.

“Management of non-penetrating renal trauma associated with urinary tract rupture [AAST Grade IV-V] is not clearly codified regarding the usefulness of upper tract drainage with stent insertion,” said Chebbi.

“Our results suggest that we should initially observe these patients with non-penetrating renal trauma and urinary extravasation. Initial clinical monitoring and a follow-up CT scan to reassess urinary leak is a good, useful, and less invasive option than a systematic urinary drainage,” he concluded.

 

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Doctor - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Roshini Claire Anthony, 4 days ago

The combined use of piperacillin and tazobactam does not appear to be a suitable alternative to meropenem for patients with bloodstream infections caused by ceftriaxone-resistant Escherichia coli (E. coli) or Klebsiella pneumoniae (K. pneumoniae), according to results of the MERINO* trial.

Tristan Manalac, 19 May 2018
Taking oral antibiotics appears to increase the risk of nephrolithiasis, according to a recent study. Moreover, the risk seems to be compounded for individuals with recent antibiotic exposure and those who were exposed at a younger age.
2 days ago
Patients with inflammatory bowel disease are at increased risk of developing acute myocardial infarction (AMI) or heart failure, although the prevalence of traditional risk factors for such cardiovascular disorders appears to be low, as reported in a recent study.
3 days ago
Early renin-angiotensin-aldosterone system (RAAS) blockade with renin-angiotensin system inhibitors (RASI) leads to better short- and long-term renal outcomes in systemic lupus erythematosus (SLE) patients with antiphospholipid-associated nephropathy (aPLN), according to a study, adding that this renal protective effect is independent of RASI’s antihypertensive and antiproteinuric effects.