A 24-year-old man sustains a blunt abdominal trauma in a road traffic accident. He is haemodynamically stable with gross haematuria. Contrast-enhanced CT shows a laceration extending through the cortex into the collecting system with extravasation of contrast, but no devitalized fragments and 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 grading: Grade III is a parenchymal laceration deeper than 1 cm without collecting system involvement. Extension into the collecting system with urinary extravasation, or any segmental vascular injury, upgrades the injury to Grade IV. Grade V requires a shattered kidney, main renal artery or vein injury, or complete avulsion. Since this patient has collecting system involvement with extravasation but no devascularization, it is Grade IV.
Reference: Campbell-Walsh Urology, 12th ed.
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