A 30-year-old man sustains blunt abdominal trauma in a road traffic accident. Contrast-enhanced CT shows a deep renal laceration more than 1 cm in depth extending into the collecting system, with extravasation of contrast-laden urine but no vascular injury. According to the AAST organ injury scale, what is the renal injury grade?

• A Grade II
• B Grade III
• C Grade V
• D Grade IV ✓

Explanation

On the AAST renal injury scale, a laceration deeper than 1 cm that extends into the collecting system with urinary extravasation, or a segmental vascular injury with contained haemorrhage, constitutes a Grade IV injury. Grade III is a laceration more than 1 cm deep that does NOT involve the collecting system, which is the distinction being tested. Grade V denotes a shattered kidney or avulsion of the renal hilum. Grades I and II are subcapsular haematoma and superficial cortical lacerations respectively.

Reference: Sabiston Textbook of Surgery, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.