Evaluating Follow‐Up and Renal Function Outcomes in Trauma Patients With Urologic Injuries: Insights From a Level I Trauma Center

PURPOSE: To assess the significance of renal dysfunction in the setting of American Association for the Surgery of Trauma (AAST) renal injuries and follow-up patterns among renal trauma (RT) patients. METHODS: We retrospectively reviewed a prospectively maintained database of patients admitted with traumatic renal injuries to a level I trauma center from 2020 to 2023. AAST grades I-III were defined as low-grade renal trauma (LGRT), and AAST grades IV-V were defined as high-grade renal trauma (HGRT). Primary outcomes were creatinine on admission and follow-up. Secondary outcomes included pre-/post-injury creatinine and AAST grade. RESULTS: Among 285 patients identified with AAST renal injuries who survived hospitalization, 97 (34.0%) had an elevated admission creatinine (median 1.44 [IQR 1.30-1.76] mg/dl). Over two-thirds of patients with elevated creatinine had LGRT. Seventy-seven (79.4%) of 97 patients with elevated creatinine had a repeat measure obtained a median of 15.5 (IQR 6.75-32.25) months post-injury. Of these, 16 (20.8%) demonstrated persistent creatinine elevation (median 1.42 [IQR 1.33-1.61] mg/dL; p < 0.001), with > 30% having LGRT. Admission and post-injury creatinine remained significantly elevated compared to pre-injury levels in both LGRT and high-grade RT (grades IV-V) (p < 0.01). No patients had creatinine intentionally assessed by any specialty service after hospitalization. CONCLUSION: One in five patients with elevated creatinine in the setting of RT may be at risk for chronic kidney disease. Follow-up should be considered for any patient with elevated creatinine, regardless of renal injury grade.