High grade renal trauma due to blunt injury in children: do all require intervention?

Govindarajan, Krishna Kumar; Utagi, Mallikarjun; Naredi, Bikash Kumar; Jindal, Bibekanand; Kumaravel, S; Subramaniam, Deepakbharathi

doi:10.1590/2175-8239-jbn-2018-0186

Cited by 10 publications

(10 citation statements)

References 8 publications

(9 reference statements)

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“…The most prominent clinical features of kidney trauma patients are ank pain and gross hematuria [1,7,11,15]. Our study also found similar results.…”

Section: Discussionsupporting

confidence: 87%

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Traumatic Kidney Injury: A 6 -Year Retrospective Study in Childhood and Adolescence

Palinrungi

Christeven

Faruk

2022

Preprint

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Introduction Traumatic kidney injuries are the most common urinary tract injuries. Pediatric patients are more susceptible to renal injury from blunt trauma than adults because of anatomic factors. The aim of this publication was to provide a reference for traumatic kidney injury in the pediatric group based on the study in our center. Methods A retrospective study was conducted from January 2014 to December 2019 to review medical records of children admitted with renal trauma. Relevant findings, including demographics, mechanisms and grades of injury, clinical parameters, interventions, and outcomes were recorded. Results Thirty-three pediatric patients were investigated. Males experienced traumatic kidney injury more often than the female with a ratio of 10:1. Most cases occurred during the adolescent (12–18) years (81.82%). Left side kidney injury (63.64%) was more frequent than right side (36.36%). Most cases (96.97%) were caused by blunt trauma, mainly traffic accidents (81.82%). Most patients (90.91%) had stable hemodynamics. Grade IV kidney injury was the most frequently found injury (39.39%). The cause of renal function disturbance was based on the blood urea nitrogen/creatinine (BUN/Cr) ratio with 21.87% of patients suffering from intra-renal causes and 12.5% from pre-renal causes. No significant association between different grades and BUN/creatinine ratio was found. Isolated renal injuries were found in 54.54% of patients. Most patients were treated conservatively (87.88%), and survival was 96.97%. Conclusion Non-operative management is safe and and yields good outcomes in kidney trauma patients with stable hemodynamics. Renal trauma severity is not associated with the BUN/Cr ratio.

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“…The most prominent clinical features of kidney trauma patients are ank pain and gross hematuria [1,7,11,15]. Our study also found similar results.…”

Section: Discussionsupporting

confidence: 87%

“…Blunt renal injuries in children are seldom isolated, and multiorgan injury (liver, spleen, closed head, orthopedic fractures) is the general rule [4]. Several associated organ injuries that are commonly found in traumatic kidney injury are spleen and liver [15]. This condition can occur due to the organs' proximity to the kidney.…”

Section: Discussionmentioning

confidence: 99%

Traumatic Kidney Injury: A 6 -Year Retrospective Study in Childhood and Adolescence

Palinrungi

Christeven

Faruk

2022

Preprint

View full text Add to dashboard Cite

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“… 6 Several associated organ injuries that are commonly found in traumatic kidney injury are spleen and liver. 25 This condition can occur due to the organs’ proximity to the kidney. The other injuries found in our study were traumatic brain injury, bone fracture, associated abdominal trauma injury, and burn injury.…”

Section: Discussionmentioning

confidence: 99%

Traumatic Kidney Injury: A 6-Year Retrospective Study in Childhood and Adolescence

Palinrungi,

Faruk,

Christeven

2023

RRU

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Background Traumatic kidney injuries are the most common urinary tract injuries. Pediatric patients are more susceptible to renal injury from blunt trauma than adults because of anatomic factors. The aim of this publication was to provide a reference for traumatic kidney injury in the pediatric group based on the study in our center. Methods A retrospective study was conducted from January 2014 to December 2019 to review medical records of children admitted with renal trauma. Relevant findings including demographics, mechanisms and grades of injury, clinical parameters, interventions, and outcomes were recorded. Results Thirty-three pediatric patients were investigated. Males experienced traumatic kidney injury more often than the females with a ratio of 10:1. Most cases occurred during the adolescent (12–18) years (81.82%). Left-side kidney injury (63.64%) was more frequent than right side (36.36%). Most cases (96.97%) were caused by blunt trauma, mainly traffic accidents (81.82%). Most patients (90.91%) had stable hemodynamics. Grade IV kidney injury was the most frequently found injury (39.39%). The cause of renal function disturbance was based on the blood urea nitrogen/creatinine (BUN/Cr) ratio with 21.87% of patients suffering from intra-renal causes and 12.5% from pre-renal causes. No significant association between different grades and BUN/creatinine ratio was found. Isolated renal injuries were found in 54.54% of patients. Most patients were treated conservatively (87.88%), and survival was 96.97%. Conclusion Non-operative management is safe and yields good outcomes in kidney trauma patients with stable hemodynamics. Renal trauma severity is not associated with the BUN/Cr ratio.

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“…With regard to other identified risk factors, isolated BRT is rarer and often presumed a more minor injury, 14,15 leading potentially to less timely evaluation. Nonetheless, case reports of severe isolated kidney injuries have been reported, 16 as well as retrospective studies suggesting isolated renal injuries are more common in younger children 17 .…”

Section: Discussionmentioning

confidence: 99%

Urine leaks in children sustaining blunt renal trauma

Ghani¹,

Snyder

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:Few consensus statements exist to guide the timely diagnosis and management of urine leaks in children sustaining blunt renal trauma (BRT). The aims of this study were to characterize kidney injuries among children who sustain BRT, evaluate risk factors for urine leaks, and describe the negative impact of urinoma on patient outcomes and resource consumption. METHODS:A retrospective review was performed of 347 patients, younger than 19 years, who presented with BRT to a single American College of Surgeons-verified Level I Pediatric Trauma Center between 2005 and 2020. Frequency of and risk factors for urine leak after BRT were evaluated, and impact on patient outcomes and resource utilization were analyzed. RESULTS:In total, 44 (12.7%) patients developed urine leaks, which exclusively presented among injury Grade 3 (n = 5; 11.4%), Grade 4 (n = 27; 61.4%), and Grade 5 (n = 12; 27.3%). A minority of urine leaks (n = 20; 45.5%) were discovered on presenting CT scan but all within 3 days. Kidney-specific operative procedures (nephrectomy, cystoscopy with J/ureteral stent, percutaneous nephrostomy) were more common among urine leak patients (n = 17; 38.6%) compared with patients without urine leaks (n = 3; 1.0%; p = 0.001). Patients with urine leak had more frequent febrile episodes during hospital stay (n = 24; 54.5%; p = 0.001) and showed increased overall 90-day readmission rates (n = 14; 33.3%; p < 0.001). Independent risk factors that associated with urine leak were higher grade (odds ratio [OR], 7.9; 95% confidence interval [CI], 2.6-24.3; p < 0.001), upper-lateral quadrant injuries (OR, 2.9; 95% CI, 1.2-7.1; p = 0.02), and isolated BRT (OR, 2.6; 95% CI, 1.0-6.5; p = 0.04). CONCLUSION:In a large cohort of children sustaining BRT, urine leaks result in considerable morbidity, including more febrile episodes, greater 90-day readmission rates, and increased operative or image-guided procedures. This study is the first to examine the relationship between kidney quadrant injury and urine leaks. Higher grade (Grade 4-5) injury, upper lateral quadrant location, and isolated BRT were independently predictive of urine leaks.

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High grade renal trauma due to blunt injury in children: do all require intervention?

Cited by 10 publications

References 8 publications

Traumatic Kidney Injury: A 6 -Year Retrospective Study in Childhood and Adolescence

Traumatic Kidney Injury: A 6 -Year Retrospective Study in Childhood and Adolescence

Traumatic Kidney Injury: A 6-Year Retrospective Study in Childhood and Adolescence

Urine leaks in children sustaining blunt renal trauma

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