Pediatric urologyHigh-grade renal injuries in children—is conservative management possible?
Section snippets
Material and methods
From 1991 to 2003, 79 consecutive patients (age range 2 to 16 years) with renal injuries were treated in an urban level I pediatric trauma center. The diagnosis of renal injury was confirmed in all patients by abdominal computed tomography (CT) scan with intravenous contrast. The grade of renal injury was classified by an independent radiologist according to the kidney injury scale of the American Association for the Surgery of Trauma organ injury severity scale.8 Grade IV renal injury was
Results
Twenty children (age range 2 to 14 years) were identified as having high-grade renal injury (10 each with grade IV and V renal injury). The characteristics of the children with high-grade injury are listed in Table I. Blunt trauma was the predominant mechanism of injury in 17 patients (85%) and was most often caused by falls (n = 11), motor vehicle accidents (n = 2), and bicycle accidents (n = 2). Children with grade V renal injuries had a greater mean injury severity score (P = 0.004) and
Comment
The incidence of renal injuries in children is difficult to define. Blunt abdominal trauma is reported to involve renal injury in 10% to 20% of cases, with 10% of those high-grade injuries.1, 3 A search of the National Pediatric Trauma Registry showed that renal trauma comprised 1.6% of total injuries.9 High-grade renal trauma was diagnosed in 20 (39%) of the 79 patients in our study. High-grade renal trauma may have been more common in our study owing to the small study size and selection
Conclusions
Children with grade IV renal injury can usually be treated conservatively. Patients with significant urinary extravasation or renal fracture should undergo a trial of urinary drainage with early ureteral stenting and bladder catheterization. Grade V injury is associated with an increased risk of requiring open operative intervention and the renal preservation rates are low.
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2020, Journal of Pediatric UrologyCitation Excerpt :Given the lack of long-term sequelae from grade I-II injuries and almost universal non-operative management of these injuries, it could be argued that diagnosing every grade I-II renal injury with CT scan may be clinically unnecessary. The use of non-operative management of higher grade injuries (IV–V) has also been reported with successful outcomes in the literature [[9,10]], further justifying the need to re-evaluate the use of routine CT scans for every pediatric renal trauma patient. Renal ultrasound is a common imaging study used in pediatric hospitals and is quickly obtained and very familiar as a diagnostic modality to pediatric urologists and radiologists.