Conservative Management of a Solitary Kidney in a Patient with Grade IV Renal Injury: A Case Report

Abstract

The kidney is the most frequently injured organ in the genitourinary system, accounting for 1 to 5% of all trauma cases. The mechanism of injury can be either blunt or penetrating. Management strategies depend on the American Association for the Surgery of Trauma (AAST) grade of injury. For injuries upto AAST grade IV conservative management is employed, whereas grade 5 requires surgical exploration. The present case report discusses a rare and challenging case of traumatic injury to a solitary kidney in a 26-year-old male, resulting from a blunt horse kick. The patient presented with severe right-sided abdominal pain and anuria for eight hours, alongside haemodynamic instability and clinical signs of renal trauma. Initial imaging revealed a grade IV renal injury with haemoperitoneum and a solitary right kidney. Conservative management was prioritised to preserve the solitary kidney. Resuscitative measures, including volume expansion, blood transfusions, and dialysis sessions, were employed, while complications such as acute kidney injury and acute respiratory distress syndrome were managed by a multidisciplinary team. A retrograde pyelogram later revealed mild pelvicalyceal dilation and contrast leakage, leading to successful decompression with silicone double-J stenting (DJ) stenting. The patient’s condition improved, with the restoration of urine output and normalisation of serum creatinine levels. Follow-up demonstrated complete recovery without further complications. The present case emphasises the importance of a conservative approach, multidisciplinary collaboration, and close monitoring in managing high-grade renal trauma involving a solitary kidney, thereby avoiding the need for nephrectomy and lifelong renal replacement therapy.