Of equal importance, the IVP should also confirm the presence and functional status of the contralateral kidney and the presence or absence of congenital anomalies, such as horseshoe or congenital single kidney. Delayed films may be necessary to visualize contrast extravasation. If the functional status of the unaffected kidney is not ascertained prior to surgical exploration, an intravenous pyelogram must be performed on the operating table prior to any attempt at exploration of the injured kidney. It has been a generally accepted practice to perform preoperative IVPs on all individuals with abdominal wounds who require laparotomy. Rena I trauma, either blunt or penetrating, may be classified according to the degree or extent of anatomical damage to the kidney.
Minor injuries consist of renal contusions or shallow cortical lacerations.
Major injuries are comprised of deep cortical lacerations, shattered kidneys, renal vascular pedicle injuries, or total avulsion of the renal pelvis. Some renal injuries will be minor and may be managed nonoperatively with hydration and bedrest. In some instances, total nephrectomy may be required. Hemodynamically significant injuries are 'addressed first. If control of hemorrhage requires exploration of the renal space, it is imperative to first gain vascular control of the renal pedicle prior to opening the perirenal fascia and releasing the relatively hemostatic tamponade.