AAST kidney trauma grading

AAST grade	Severity imaging criteria (CT findings)	Operative goals	Pathologic criteria
I	Subcapsular hematoma and/or parenchymal contusion without laceration	Nonexpanding subcapsular hematoma Parenchymal contusion without laceration	Subcapsular hematoma or parenchymal contusion without parenchymal laceration
II	Perirenal hematoma confined to Gerota fascia Renal parenchymal laceration ≤1 cm depth without urinary extravasation	Nonexpanding perirenal hematoma confined to Gerota fascia Renal parenchymal laceration ≤1 cm depth without urinary extravasation	Perirenal hematoma confined to Gerota fascia Renal parenchymal laceration ≤1 cm depth without urinary extravasation
III	Renal parenchymal laceration >1 cm depth without collecting system rupture or urinary extravasation Any injury in the presence of a kidney vascular injury or active bleeding contained within Gerota fascia	Renal parenchymal laceration >1 cm depth without collecting system rupture or urinary extravasation	Renal parenchymal laceration >1 cm depth without collecting system rupture or urinary extravasation
IV	Parenchymal laceration extending into urinary collecting system with urinary extravasation Renal pelvis laceration and/or complete ureteropelvic disruption Segmental renal vein or artery injury Active bleeding beyond Gerota fascia into the retroperitoneum or peritoneum Segmental or complete kidney infarction(s) due to vessel thrombosis without active bleeding	Parenchymal laceration extending into urinary collecting system with urinary extravasation Renal pelvis laceration and/or complete ureteropelvic disruption Segmental renal vein or artery injury Segmental or complete kidney infarction(s) due to vessel thrombosis without active bleeding	Parenchymal laceration extending into urinary collecting system Renal pelvis laceration and/or complete ureteropelvic disruption Segmental renal vein or artery injury Segmental or complete kidney infarction(s) due to vessel thrombosis without active bleeding
V	Main renal artery or vein laceration or avulsion of hilum Devascularized kidney with active bleeding Shattered kidney with loss of identifiable parenchymal renal anatomy	Main renal artery or vein laceration or avulsion of hilum Devascularized kidney with active bleeding Shattered kidney with loss of identifiable parenchymal renal anatomy	Main renal artery or vein laceration or avulsion of hilum Devascularized kidney Shattered kidney with loss of identifiable parenchymal renal anatomy

Vascular injury is defined as a pseudoaneurysm or arteriovenous fistula and appears as a focal collection of vascular contrast that decreases in attenuation with delayed imaging. Active bleeding from a vascular injury presents as vascular contrast, focal or diffuse, that increases in size or attenuation in delayed phase. Vascular thrombosis can lead to organ infarction.
Grade based on highest grade assessment made on imaging, at operation or on pathologic specimen.
More than one grade of kidney injury may be present and should be classified by the higher grade of injury.
Advance one grade for bilateral injuries up to Grade III.

AAST: American Association for the Surgery of Trauma; AIS: Abbreviated Injury Scale; CT: computed tomography.

From: Kozar RA, Crandall M, Shanmuganathan K, et al. Organ injury scaling 2018 update: Spleen, liver, and kidney. J Trauma Acute Care Surg 2018; 85:1119. DOI: 10.1097/TA.0000000000002058. Copyright © 2018 American Association for the Surgery of Trauma. Reproduced with permission from Wolters Kluwer Health. Unauthorized reproduction of this material is prohibited.

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AAST kidney trauma grading