A 24-year-old man sustains blunt abdominal trauma in a road traffic accident. He presents with left flank pain and gross haematuria. Contrast-enhanced CT shows a laceration more than 1 cm deep extending into the collecting system with extravasation of contrast-laden urine. There is no vascular injury. What is the AAST grade of this renal injury?
- A Grade II
- B Grade IV ✓
- C Grade III
- D Grade V
Correct answer: B. Grade IV
Explanation
AAST grade IV renal injury comprises a laceration greater than 1 cm in depth extending into the collecting system with urinary extravasation, or any segmental vascular injury with contained haemorrhage. Grade III is a laceration deeper than 1 cm without collecting system involvement, so the absence of urine leak would be needed for C. Grade V is reserved for shattered kidney or complete avulsion of the renal hilum, neither of which is present here.
Reference: Campbell-Walsh Urology, 12th ed.
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