A 45-year-old man with blunt abdominal trauma from a fall is found to have a retroperitoneal haematoma on CT scan. The haematoma is confined to the perinephric space around the right kidney, and the patient is haemodynamically stable. Urinalysis shows 15–20 RBCs per high-power field. What is the most appropriate management?

Explanation

## Blunt Renal Trauma Management ### Grading and Haemodynamic Stability: Renal injuries are graded I–V based on CT findings. A perinephric haematoma (typically Grade II–III) in a **haemodynamically stable patient** is managed conservatively. ### Management Principles: 1. **Haemodynamic stability** is the key criterion for non-operative management 2. **Bed rest** and observation (ICU/HDU as appropriate) 3. **Serial clinical examination** and haemoglobin monitoring 4. **Repeat imaging** only if clinical deterioration (fever, worsening pain, haemodynamic instability) 5. **Prophylactic antibiotics** if gross haematuria or significant injury ### Success Rate: - >95% of blunt renal injuries heal with conservative management in haemodynamically stable patients - Nephrectomy is reserved for: - Haemodynamic instability despite resuscitation - Shattered kidney (Grade V) - Renal artery thrombosis with ischaemia **Clinical Pearl:** Retroperitoneal drainage is NOT routinely performed; it increases infection risk and is reserved for infected haematomas (abscess formation). **Key Point:** Microscopic haematuria alone does not mandate intervention; it is expected in renal injury.