Note: illustration not yet up to date.

Classification Description Notes
Grade 1 – Subcapsular hematoma and/or parenchymal contusion without laceration  
Grade 2 – Perirenal hematoma confined to Gerota fascia

– Renal parenchymal laceration ≤1 cm depth without urinary extravasation

Grade 3 – 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

Grade 4 – 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

Grade 5 – Main renal artery or vein laceration or avulsion of hilum

– Devascularized kidney with active bleeding

– Shattered kidney with loss of identifiable parenchymal renal anatomy


Note: Advance one grade for bilateral injuries up to grade 3.



Kozar RA et al. (2018). Organ injury scaling 2018 update: Spleen, liver, and kidney. J Trauma Acute Care Surg; 85(6):1119- 1122