A 26-year-old motorcyclist sustains blunt left flank trauma in a road traffic accident. Contrast-enhanced CT shows a deep parenchymal laceration extending into the renal collecting system with urinary extravasation on delayed images. There is no vascular injury or devitalised fragment and the contralateral kidney is normal. According to the AAST organ injury scale, what is the grade of this renal injury?
- A Grade II
- B Grade III
- C Grade IV ✓
- D Grade V
Correct answer: C. Grade IV
Explanation
AAST Grade IV includes lacerations extending into the collecting system with urinary extravasation, any vascular injury to segmental renal vessels with contained haemorrhage, or devitalised parenchyma without other injuries. Grade III is limited to lacerations greater than 1 cm depth without collecting system involvement, which does not apply here. Grade V denotes shattered kidney, hilar avulsion, or main renal vessel injury. Such Grade IV injuries are managed conservatively unless bleeding or sepsis supervenes.
Reference: Campbell-Walsh Urology, 12th ed.
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