[Diagnostic and therapeutic consequences of kidney injuries in pediatric blunt abdominal trauma]

Renal lesions are frequently encountered in blunt pediatric abdominal trauma. In this retrospective study, we analyzed the incidence of renal trauma in these trauma patients to determine which diagnostic and therapeutic approaches were most predictive. From 1976 to 1996, 308 children sustaining blunt abdominal trauma were admitted to our department. Patients were evaluated using abdominal paracentesis, ultrasonography, and urinary analysis. In specific cases, i.v. urography, CT scan, and/or angiography were applied. We used the Organ Injury Scale (OIS) for classification of renal trauma into five grades. We encountered 69 serious abdominal traumas. Thirty-six patients sustained renal lesions grade 2 (G2) or higher; 20 children were polytraumatized. There were 67 renal lesions with 28 G1, 22 G2, 8 G3, 5 G4, 1 G5, and 3 lesions of the urinary tract. Ultrasonography and urinary analysis were found to be optimal diagnostic means for screening and observing the course of renal lesions. For lesions G2 or higher, CT scan was the most reliable in classifying and diagnosing renal lesions. This superseded i.v. urography. If no contrast medium was excreted in the CT scan, angiography was indicated. Only ten patients proceeded to operative therapy. During the period reviewed, a shift from operative to conservative treatment was notable with a tendency toward minimally invasive therapy. If lesions were G4 or G5, operative treatment was always indicated.