Blunt renal trauma in pediatric population

Abstract

Aims: This study aims to evaluate the magnitude and impact of renal trauma among pediatric population and to assess the effectiveness of conservative versus operative management. Subjects and Methods: All pediatric patients (age <18 years) with blunt renal trauma, who presented to King Khalid National Guard Hospital in Jeddah between January 2000 and December 2012, were retrospectively reviewed. Medical records were reviewed for demographics, mechanism of injury, length of hospital stay, grade of renal trauma, hematuria, renovascular injuries, associated nonrenal injuries, conservative versus operative management, renal outcomes, and complications. Results: Fifteen children with a blunt renal injury were identified, of which 14 met data inclusion criteria. The renal injury population had a mean age of 12.7 years (standard deviation 4.6) and was 85.7% male. The renal injuries were distributed as follows: Grade 1, n = 3 (21.4%); Grade 2, n = 3 (21.4%); Grade 3, n = 3 (21.4%); Grade 4, n = 3 (21.4%); and Grade 5, n = 2 (14.2%). Macroscopic hematuria was present in 64.3% of children. The median hospital length of stay was 13 days. Eleven children (78.5%) had traumatic injuries in multiple organs. Overall, 10 children (71.4%) were managed conservatively. Four children (28.5%) with high-grade trauma required operative intervention. Renovascular injuries were found in 4 cases (80%) of high-grade renal injuries. Conclusions: Conservative management of kidney injuries was highly successful in children with low-grade renal trauma. Furthermore, operative intervention in high-grade renal injuries proved to be successful and had good renal outcomes. Renal preservation was achieved in 92.8% of cases.