AAST kidney injury scale

Changed by Craig Hacking, 14 Dec 2018

Updates to Article Attributes

Body was changed:

Show markup changes

The 2018 update of the American Association for the Surgery of Trauma (AAST) renal injury scaleis the most widely used grading system for renal trauma at the time of writing (late 2018) ⁸. Severity is assessed according to the depth of renal parenchymal damage and involvement of the urinary collecting system and renal vessels.

Classification

grade I:
- subcapsular haematoma or contusion, without laceration
grade II:
- superficial laceration ≤1 cm depth not involving the collecting system (no evidence of urine extravasation)
- perirenal haematoma confined within the perirenal fascia
grade III:
- laceration >1 cm not involving the collecting system (no evidence of urine extravasation)
- vascular injury or active bleeding confined within the perirenal fascia
grade IV
- laceration involving the collecting system with urinary extravasation
- laceration of the renal pelvis and/or complete uretopelvic disruption
- vascular: injury to segmental renal artery or vein
- segmental infarctions without associated active bleeding (i.e. due to vessel thrombosis)
- active bleeding extending beyond the perirenal fascia (i.e. into the retroperitoneum or peritoneum)
grade V
- shattered kidney
- avulsion of renal hilum or laceration of the main renal artery or vein: devascularisation of a kidney due to hilar injury
- devascularised kidney with active bleeding

NB. advance one grade for bilateral injuries up to grade III.

If a renal injury is detected on a routine trauma portal venous phase CT of the abdomen without evidence of urine extravasation, then a delayed phase at 5-15 minutes should be considered to assess for urine extravasation, especially if there are clinical signs of collecting system injury (e.g. haematuria or blood at the meatus) ⁵. This should not necessarily be performed if the patient is unstable or if there are other large, life-threatening injuries.

~~-<li>perirenal haematoma confined within the <a title="Perirenal fascia" href="/articles/perirenal-fascia">perirenal fascia</a>~~
+<li>perirenal haematoma confined within the <a href="/articles/perirenal-fascia">perirenal fascia</a>
~~-<li>vascular injury or active bleeding confined within the <a title="perirenal fascia" href="/articles/perirenal-fascia">perirenal fascia</a>~~
+<li>vascular injury or active bleeding confined within the <a href="/articles/perirenal-fascia">perirenal fascia</a>
~~-<li>vascular: injury to segmental <a title="Renal artery" href="/articles/renal-artery">renal artery</a> or <a title="Renal vein" href="/articles/renal-vein-1">vein</a>~~
+<li>vascular: injury to segmental <a href="/articles/renal-artery">renal artery</a> or <a href="/articles/renal-vein-1">vein</a>
-<li>active bleeding extending beyond the <a title="Perirenal fascia" href="/articles/perirenal-fascia">perirenal fascia</a> (i.e. into the <a title="Retroperitoneum" href="/articles/retroperitoneum">retroperitoneum</a> or <a title="Peritoneum" href="/articles/peritoneum">peritoneum</a>)</li>
+<li>active bleeding extending beyond the <a href="/articles/perirenal-fascia">perirenal fascia</a> (i.e. into the <a href="/articles/retroperitoneum">retroperitoneum</a> or <a href="/articles/peritoneum">peritoneum</a>)</li>
-<li>avulsion of renal hilum or laceration of the main <a title="Renal artery" href="/articles/renal-artery">renal artery</a> or <a title="Renal vein" href="/articles/renal-vein-1">vein</a>: <a href="/articles/renal-vascular-pedicle-injury-2">devascularisation of a kidney due to hilar injury</a>
+<li>avulsion of renal hilum or laceration of the main <a href="/articles/renal-artery">renal artery</a> or <a href="/articles/renal-vein-1">vein</a>: <a href="/articles/renal-vascular-pedicle-injury-2">devascularisation of a kidney due to hilar injury</a>

References changed:

8. Kozar R, Crandall M, Shanmuganathan K et al. Organ Injury Scaling 2018 Update: Spleen, Liver, and Kidney. J Trauma Acute Care Surg. 2018;85(6):1119-22. <a href="https://doi.org/10.1097/ta.0000000000002058">doi:10.1097/ta.0000000000002058</a>
8. Kozar RA, Crandall M, Shanmuganathan K, Zarzaur BL, Coburn M, Cribari C, Kaup K, Schuster K, Tominaga GT. Organ injury scaling 2018 update: Spleen, liver, and kidney. (2018) The journal of trauma and acute care surgery. 85 (6): 1119-1122.

ADVERTISEMENT: Supporters see fewer/no ads

{"current_user":null,"inclusions":[{"imageId":13970075,"studyId":39737,"caseSlug":"renal-trauma-grading-diagrams","caption":"Figure 1","thumbnail":"https://prod-images-static.radiopaedia.org/images/13970075/060fce46d98d53a2bfb628ffefa05d_big_gallery.jpg","isStack":false,"diagnosticCertainty":"not_applicable"},{"imageId":9021199,"studyId":33017,"caseSlug":"hilar-liver-laceration-and-subcapsular-renal-haematoma","caption":"Case 1: grade I","thumbnail":"https://prod-images-static.radiopaedia.org/images/9021199/a18d05b44a66579acc1d33b7df16fc_big_gallery.jpg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":13970076,"studyId":39737,"caseSlug":"renal-trauma-grading-diagrams","caption":"Figure 2","thumbnail":"https://prod-images-static.radiopaedia.org/images/13970076/f729f0565ea8129fd5e690373e0878_big_gallery.jpg","isStack":false,"diagnosticCertainty":"not_applicable"},{"imageId":4616684,"studyId":24938,"caseSlug":"traumatic-renal-laceration","caption":"Case 2: grade II","thumbnail":"https://prod-images-static.radiopaedia.org/images/4616684/6c02c09743fbebf703a3d2131123ce_big_gallery.jpg","isStack":false,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":13970078,"studyId":39737,"caseSlug":"renal-trauma-grading-diagrams","caption":"Figure 3","thumbnail":"https://prod-images-static.radiopaedia.org/images/13970078/1851dc4da8541a1277eae2160d210c_big_gallery.jpg","isStack":false,"diagnosticCertainty":"not_applicable"},{"imageId":9019013,"studyId":33014,"caseSlug":"renal-injury-aast-grade-iv-2","caption":"Case 3: grade IV","thumbnail":"https://prod-images-static.radiopaedia.org/images/9019013/b8a60f639d567d44452e4622077452_big_gallery.jpg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":13970080,"studyId":39737,"caseSlug":"renal-trauma-grading-diagrams","caption":"Figure 4","thumbnail":"https://prod-images-static.radiopaedia.org/images/13970080/d48248e116cd0453f2e974f4bbfbcc_big_gallery.jpg","isStack":false,"diagnosticCertainty":"not_applicable"},{"imageId":6539445,"studyId":28855,"caseSlug":"stellate-liver-and-right-kidney-lacerations","caption":"Case 4: grade IV ","thumbnail":"https://prod-images-static.radiopaedia.org/images/6539445/e6ec66b5a0e288d926c13567fc80f9_big_gallery.jpg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":14052923,"studyId":39737,"caseSlug":"renal-trauma-grading-diagrams","caption":"Figure 5","thumbnail":"https://prod-images-static.radiopaedia.org/images/14052923/b00dbdc2816e303a2b7627673faa12_big_gallery.jpg","isStack":false,"diagnosticCertainty":"not_applicable"},{"imageId":3972793,"studyId":23411,"caseSlug":"traumatic-renal-and-splenic-injury-1","caption":"Case 5: grade IV","thumbnail":"https://prod-images-static.radiopaedia.org/images/3972793/6af7545101647d9ab8cabfa04f92f3_big_gallery.jpg","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":51423889,"studyId":80553,"caseSlug":"renal-trauma-grading-diagrams-1","caption":"Figure 6","thumbnail":"https://prod-images-static.radiopaedia.org/images/51423889/27ee6357966d57e60025316afecc53_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"not_applicable"},{"imageId":18786,"studyId":37746,"caseSlug":"renal-vascular-pedicle-injury","caption":"Case 6: grade V ","thumbnail":"https://prod-images-static.radiopaedia.org/images/18786/52dff4389f727f9fd6c994396d734e_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":622801,"studyId":12707,"caseSlug":"renal-splenic-and-hepatic-lacerations","caption":"Case 7: grade V - shattered kidney","thumbnail":"https://prod-images-static.radiopaedia.org/images/622801/15db6019dfa3f70f81ad066d91a96816ca1d34ee685de509e4752ae50f03528c_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":1340385,"studyId":14746,"caseSlug":"traumatic-renal-and-splenic-injury","caption":"Case 8: grade V + concurrent splenic injury","thumbnail":"https://prod-images-static.radiopaedia.org/images/1340385/cae2c9a12411b67d1b4272da8d16c4_big_gallery.jpg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":2518614,"studyId":20120,"caseSlug":"multiorgan-trauma-with-grade-v-renal-injury","caption":"Case 9: grade V","thumbnail":"https://prod-images-static.radiopaedia.org/images/2518614/0bdeb1be25f3192565c6b1c77f832e_big_gallery.jpg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":17045185,"studyId":43437,"caseSlug":"renal-trauma-aast-grade-v-injury-3","caption":"Case 10: grade V","thumbnail":"https://prod-images-static.radiopaedia.org/images/17045185/7a6b4e05e77d61b764eb6ab979c110_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":29250454,"studyId":57938,"caseSlug":"renal-trauma-aast-grade-iv-injury-6","caption":"Case 11: grade IV ","thumbnail":"https://prod-images-static.radiopaedia.org/images/29250454/2c25340bc4b5299945d4b0a2b6bf9f_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"probable"},{"imageId":59315014,"studyId":124793,"caseSlug":"traumatic-renal-injury-aast-grade-iv-injury-1","caption":"Case 12: grade IV","thumbnail":"https://prod-images-static.radiopaedia.org/images/59315014/01e32a8f36c0a47e71967144b036a8e346e57a039990b4d7df34c5620fe35f59_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":61138675,"studyId":132183,"caseSlug":"subcapsular-perirenal-haematoma-4","caption":"Case 13: grade I","thumbnail":"https://prod-images-static.radiopaedia.org/images/61138675/6af3ec632da0b34cc81530a94c8fbe6e95a2562e283b0003c45b28e3d6882669_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"}],"ddx_inclusions":[],"lang":"us"}

Updating… Please wait.

Unable to process the form. Check for errors and try again.

Thank you for updating your details.

AAST kidney injury scale

Updates to Article Attributes

Classification

See also

Articles

By Section:

By System:

Cases

Radiopaedia.org