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Congenital urinary tract anomalies in pediatric renal trauma patients
Irene M McAleer1, George W Kaplan, Barry E LoSasso
1Urology Department, Children's Hospital and Health Center, San Diego, CA, USA.
Purpose:
Congenital genitourinary tract anomalies occur commonly in the general population. Anomalous kidneys are thought to be more frequently injured by trauma than normal kidneys. We reviewed patients with renal injuries to determine the etiology, severity, associated injuries and associated congenital genitourinary abnormalities.
Materials And Methods:
A retrospective review of renal injuries was performed on patients evaluated and/or admitted to the trauma service. Severity, outcome, external cause of injury and patient demographics were evaluated. Patients were excluded from study if there was no radiographic or physical (postmortem or surgical) evidence of injury. Findings on urinalysis alone did not confirm a renal injury without other evidence. Trauma registry data from all enrolled patients were used for comparison.
Results:
A total of 14,763 patients were enrolled in the trauma registry from July 1984 to December 2000, of whom 384 (2.6%) were given a diagnosis of renal injury but only 193 (1.3%) with radiographic or other physical evidence of renal injury were included in this review. Of the 16 renal injury patients (8.3%) 15 boys (93.8%) and 1 girl (6.2%) had congenital genitourinary abnormalities. Of the 193 patients 136 boys (70.5%) and 57 girls (29.5%) sustained renal injuries. A total of 20 patients (10.4%) died of injuries but none had a genitourinary anomaly. The genitourinary anomaly group had 6, and the entire renal injury group had 298 associated injuries. Only 6 patients with congenital genitourinary anomalies required surgical procedures primarily for elective repair of ureteropelvic junction obstruction. The most common external sources of injury, primarily falls, recreational or motor vehicle accidents, were similar for all patients, all renal injury patients and those renal injury patients with congenital genitourinary abnormalities.
Conclusions:
Renal injuries occur in about 1.3% of trauma patients (193 of 14,763) and 8.3% of the renal injury patients had congenital abnormalities (16 of 193). Most injuries occurred with falls or recreational activities. This population is small but the injuries were nonlife threatening and renal salvage was likely with or without surgery. Congenital genitourinary anomalies may not increase risk of morbidity.