Nephrectomy following trauma--impact on patient outcome.

Nephrectomy for trauma is done infrequently due to the success of renal sparing procedures. The purpose of this review was to quantitate the effect of nephrectomy on patient outcome. Over a 5-year period 55 of 783 patients had renal injuries confirmed at trauma laparotomy. Nephrectomy was performed in 14 (25%) of these patients. Thirteen patients had penetrating injuries (12 gunshot wounds, one stab wound) and one patient was the victim of blunt trauma. The average number of associated injuries was 3.6. Three patients exsanguinated intraoperatively. Renal failure (serum creatinine greater than 2.5 mg%) developed in four patients; three required hemodialysis. The average time of onset of renal dysfunction was 3 weeks, and in every case it was preceded by intra-abdominal sepsis. Two patients died, both from multiple organ failure, on postoperative day 25 and 26, respectively. In the seven patients free of renal failure, one patient developed sepsis and subsequently died. Of the eight surviving patients, all had adequate renal function as evidenced by an average blood urea nitrogen of 14 mg%, serum creatinine of 1.3 mg%, and a creatinine clearance of 77 ml/min. Renal failure following nephrectomy for trauma occurs late in the hospital course and is invariably preceded by sepsis. Nephrectomy is a marker of severe intra-abdominal injury, but in itself is not the major determinant of survival.