Long-Term Renal Function Assessment With Dimercapto-Succinic Acid Scintigraphy After Conservative Treatment of Major Renal Trauma Gaelle Fiard, Jean-Jacques Rambeaud, Jean-Luc Descotes, Bernard Boillot, Nicolas Terrier, Caroline Thuillier, Marine Chodez, Olivier Skowron, Alexis Arvin Berod, Valentin Arnoux and Jean-Alexandre Long* From the Department of Urology, Grenoble University Hospital, Grenoble, France Abbreviations and Acronyms AAST = American Association for the Surgery of Trauma CT = computerized tomography DMSA = dimercapto-succinic acid Submitted for publication August 11, 2011. Study received institutional review board ap- proval. * Correspondence: Urology Department, Gre- noble University Hospital, 38043 Grenoble Cedex 9, France (e-mail: JALong@chu-grenoble.fr). Purpose: The management of high grade blunt renal injury has evolved with time to become increasingly conservative with the ultimate objective of renal preservation. We evaluated relative renal function with dimercapto-succinic acid renal scintigraphy 6 months after major renal trauma (grade IV or V). Materials and Methods: This prospective observational study was done between January 2004 and April 2010. All patients who presented with grade IV or V renal trauma and were treated conservatively were included in analysis. Patient and trauma characteristics, and initial management were recorded. Relative renal function was evaluated by dimercapto-succinic acid renal scintigraphy 6 months after trauma. Results: A total of 88 patients were included in the study. Conservative man- agement was possible in 79 patients (90%), including 69 and 10 with grade IV and V trauma, respectively. Dimercapto-succinic acid renal scintigraphy was done at 6 months for 22 patients (28%). Mean relative renal function for grade IV and V injuries was 39% and 11%, respectively (p = 0.0041). The percent of devascular- ized parenchyma (p = 0.0033) and the vascular subtype of grade IV injuries (p = 0.0194) also correlated with decreased renal function. No complication or de novo arterial hypertension was noted. Conclusions: Conservative treatment achieves the objective of renal function preservation for grade IV lesions. Grade V and specific subtypes of grade IV injury have a poor functional outcome. Further study must be performed to determine which patients will benefit from conservative treatment vs early nephrectomy to avoid a longer hospital stay and useless procedures. Key Words: kidney; wounds, nonpenetrating; radionuclide imaging; succimer; nephrectomy THE management of high grade blunt renal injury has evolved with time based on multiple series encourag- ing an increasingly conservative ap- proach 1,2 in stable and even recently in unstable patients 3 with the ulti- mate objective of renal preservation. Based on the AAST Organ Injury Se- verity Score 4 the outcome of high grade (grades IV and V) renal injury has been well studied in children 5–7 but less in adults, 8,9 mostly with ret- rospective data and renal function evaluation by serum creatinine. There has long been interest in quantitative DMSA renal scintigra- phy for long-term evaluation of renal function after surgery or trauma. 10,11 1306 www.jurology.com 0022-5347/12/1874-1306/0 Vol. 187, 1306-1309, April 2012 THE JOURNAL OF UROLOGY ® Printed in U.S.A. © 2012 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION AND RESEARCH,INC. DOI:10.1016/j.juro.2011.11.103