Objective
To determine if traumatic renal injuries or computed tomography (CT) findings are
predictive of hypertension (HTN) development following injury.
Methods
A retrospective review of a renal trauma database was performed from 1995 to 2015.
Renal injuries were graded by the American Association for the Surgery of Trauma system,
with high-grade defined as IV or V. Nonrenal genitourinary trauma (ie bladder, penile,
urethral, and testicular) patients were selected as controls. Patients with a diagnosis
of HTN before their trauma or those lacking follow-up were excluded. Risk factors
associated with HTN following trauma were identified using multivariable regression
with propensity scoring.
Results
In total, 163 patients had a renal injury and 60 had nonrenal, genitourinary injuries.
The median age was 31 years (interquartile range 23-43) with median follow-up of 4.7
years (interquartile range 1.9-8.5). Twenty-three (14%) patients with renal trauma
were newly diagnosed with HTN on follow-up, compared with 2 (3%) in the control groups.
(P = .02) After propensity quartile adjustment, patients with high-grade trauma had
higher odds of developing HTN compared with low-grade renal trauma patients and controls
(adjusted odds ratio 3.5, 95% confidence interval 1.3-9.3, P = .01). Patients with a midpole medial laceration and medial blood on CT had higher
odds of developing HTN compared with patients without these characteristics (odds
ratio 5.36, 95% confidence interval 1.3-22.6, P = .02).
Conclusion
Increasing renal trauma grade is a risk factor for future development of HTN. CT findings
at trauma presentation may be useful in stratifying patients who are at increased
risk.
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Article info
Publication history
Published online: March 12, 2018
Accepted:
October 5,
2017
Received:
September 7,
2017
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Authorship contributions: Study concept and design, analysis and interpretation of data, drafting of manuscript: ECO; analysis and interpretation of data, drafting of manuscript: MAA; analysis and interpretation of data, drafting of manuscript: GPM; analysis and interpretation of data, drafting of manuscript: TWG; acquisition of data: JY; critical revision: JWM; acquisition of data: TC; study conception and design, critical revision: BNB.
Funding Support: The Alafi Foundation provided funding for this project.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
