Effects of blast injury on kidneys in abdominal gunshot wounds

Objectives. To determine the rate of renal fragmentation resulting from blast effects and perform microscopic examination of renal arteries after gunshot wounds resulting from a high-velocity bullet. Methods. A total of 194 patients with gunshot wounds due to blast effects underwent surgical exploration. Of the 194 patients, 35 (18%) had 37 renal unit injuries (2 patients had bilateral renal injury). Of the 37 renal units, 32 were treated with nephrectomy and 5 with renoraphy. During surgical exploration, 7 patients were found to have renal fragmentation resulting from blast effects. The distance between the bullet direction in the body and the renal parenchyma was evaluated. Also, the histologic changes in the renal artery were examined microscopically. Results. Although the renal injury rate from abdominal gunshot wounds due to high-velocity bullets was 18%, the renal fragmentation rate due to blast effect was 0.36%. The mean distance between the bullet direction in the body and the renal parenchyma in patients with renal fragmentation was 2.2 cm (range 1 to 5). Two patients had intimal lacerations and one had minimal thrombosis. Conclusions. Renal fragmentation from the blast effect in these patients was closely related to the distance between the bullet direction in the body and the renal parenchyma. The possibility was greater for close-range (less than 50 m) gunshots. We believe that the histologic changes in the renal artery are not very important in the patients.