Classification of renal injuries as a guide to therapy.

Renal injuries require immediate or early surgical intervention for threatened exsanguination, damage to the pedicle vessels and disruption of the renal pelvis. Elective delayed operation prevents late complications in those patients in whom there is transparenchymal connection between the pelvocaliceal system and the perirenal space following trauma. There appears to be an increased incidence of nephrectomy if the latter are explored early. Expectant treatment is appropriate for renal lacerations without extravasation, if there is no threat of exsanguination and if the pedicle is intact.