Sabadash M. Predictors of complications after conservative, minimally invasive and surgical treatment of blunt kidney injury

The thesis is devoted to aspects determine the optimal treatment strategy in patients with blunt kidney trauma. The paper analyzed 301 patients with isolated blunt kidney injury. The patients were studied divided into two groups - main (n = 171) and control (n = 130). The control group included patients which treated from 1989 to 2003, the effectiveness of treatment which was analyzed retrospectively, and the main group - patients with blunt renal trauma (BRT) treated from 2004 to 2014, the effectiveness of treatment which was analyzed prospectively in this group included 21 patients which were held a session superselective angiography with embolization.Based on comparative analysis of results of treatment of the aforementioned groups is set high efficiency of conservative and minimally invasive treatment of patients with I-IV degree blunt renal injury. It is established that the use of maximum conservative approach to treating patients with blunt renal injury, which was applied to the patients of the main group reduced the number nephreсtomy from 15.38 % to 2.92 %, compared with the control group, p < 0,05. Determined that the technical success of angiography with embolization superselective is 90.2 %.Complications in late posttraumatic period for conservative treatment of blunt renal trauma II-III heaviness in hemodynamically stable patients are less common (2.42 % III. - 4.84 %) than after the organ safety operations (12.5 %) and are had easier character (7.26 vs 12.5 %, p > 0.05). Based on multivariate analysis, predictors of immediate surgical treatment with a probability of 95 % or higher are: unstable hemodynamics which not treated by conservative treatment (SAT - p = 0.003;); Indications for superselective embolization are: hemoglobin level at admission (p = 0.041), increasing retroperitoneal hematoma (p < 0.001,), the means of transfusion (p < 0.001); successful conservative treated; first and second degree of kidney injury (p = 0.043).Therefore, using the maximal conservative tactics and angiography with superselective embolization are priority methods of treatment patients with blunt renal injury except contraindications.