Characteristics and management of blunt renal injury in children

Abstract

Background:Renal trauma in the pediatric population is predominately due to blunt mechanism of injury. Our purpose was to determine the associated injuries, features, incidence, management, and outcomes of kidney injuries resulting from blunt trauma in the pediatric population in a single level I trauma center.Methods:This was a retrospective chart and trauma registry review of all pediatric blunt renal injuries at a regional level I trauma center that provides care to injured adults and children. The inclusion dates were January 2001–June 2014.Results:Of 5790 pediatric blunt trauma admissions, 68 children sustained renal trauma (incidence: 1.2%). Only two had nephrectomies (2.9%). Five renal angiograms were performed, only one required angioembolization. Macroscopic hematuria rate was significantly higher in the high-grade injury group (47% vs. 16%; P = 0.031). Over half of the patients had other intra-abdominal injuries. The liver and spleen were the most frequently injured abdominal organs.Conclusion:Blunt renal trauma is uncommon in children and is typically of low American Association for the Surgery of Trauma injury grade. It is commonly associated with other intra-abdominal injuries, especially the liver and the spleen. The nephrectomy rate in pediatric trauma is lower compared to adult trauma. Most pediatric blunt renal injury can be managed conservatively by adult trauma surgeons.

Haematuria in Sport: A Review

“…Ishida et al [21] found similar findings more recently examining renal trauma injuries in children, with 11.7% having no signs of haematuria. One patient had no haematuria despite high-grade renal injury (Table 2).…”

“…Evidence from further studies would suggest that any presentation with macroscopic haematuria following sporting activity, particularly contact sports, mandates full urological investigation as the risk of high-grade renal injury is significant [20][21][22][23][24]. The risk of renal injury with no detectable haematuria varies from 8% to 27%.…”

Management of grade IV blunt renal trauma in adults: Systematic review and meta-analysis

“…Among the grading classifications, grade IV is described as involvement of parenchymal laceration extending to the corticomedullary junction and the collecting system and vascular injury to the segmental renal artery or vein with contained hemorrhage/hematoma. [27][28][29] Although our study showed comparability between conservative and surgical managements in patients with grade IV blunt kidney trauma, the trend of mortality was more likely in the surgical group than in the conservative group. Based on this finding, several other studies have indicated the superiority of conservative management over surgical management.…”

“…27,28 In particular, blunt injury is more prevalent, accounting for 71%-95% of all trauma cases. 27,28 Deceleration injury in blunt trauma causes disturbances due to renal injury by the major surrounding attachment elements, such as renal pedicle and uretero-pelvic junction, whereas acceleration injury causes disturbances due to collision of the kidney with surrounding elements, such as the ribs and spine. 27,28 These two mechanisms lead to kidney injury with varying degrees of severity.…”

“…27,28 Deceleration injury in blunt trauma causes disturbances due to renal injury by the major surrounding attachment elements, such as renal pedicle and uretero-pelvic junction, whereas acceleration injury causes disturbances due to collision of the kidney with surrounding elements, such as the ribs and spine. 27,28 These two mechanisms lead to kidney injury with varying degrees of severity. This varying severity is now used as a treatment approach toward the condition, and the AAST classification system is among the most frequently used tools.…”