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Published on: February 2, 2021
Management of major blunt pediatric renal trauma: single-center experience
A Z Mohamed1, H A Morsi, A M Ziada
1Division of Pediatric Urology, Cairo University Pediatric Hospital, Cairo, Egypt. ahmadzakaria1@gmail.com
Insights
Pediatric major renal trauma management shows favorable outcomes, with no significant long-term impact on kidney function or hypertension. Further follow-up is recommended for comprehensive assessment.
Area of Science:
- Pediatric surgery
- Nephrology
- Trauma care
Background:
- Major pediatric renal trauma requires careful management to optimize long-term kidney health.
- Understanding the impact of trauma severity and treatment on renal function is crucial.
Purpose of the Study:
- To evaluate the long-term effects of pediatric major renal trauma and its management on kidney function and morphology.
- To assess the outcomes of both operative and non-operative management strategies.
Main Methods:
- Retrospective review of 36 pediatric blunt trauma patients (2004-2007) with 37 injured renal units (grades III-V).
- Management was primarily non-operative unless patients were vitally unstable.
- Follow-up averaged 14 months, assessing renal function, morphology, and development of hypertension.
Main Results:
- Non-operative management (63.2%) yielded excellent outcomes in 75% of patients, with kidney preservation and no urinary extravasation.
- Surgical intervention (36%) was reserved for high-grade injuries (V and IV), with procedures including laceration repair, partial nephrectomy, and nephrectomy.
- Follow-up revealed no significant changes in renal function or new-onset hypertension; one death occurred due to unrelated central nervous system injury.
Conclusions:
- Overall, the management of pediatric major renal trauma in this cohort was favorable.
- Longer-term follow-up is necessary to fully ascertain the impact on renal function and the potential development of hypertension.
Objective:
To review the impact of major pediatric renal trauma and its management on long-term function and morphology of the injured kidney.
Methods:
Thirty-six blunt trauma patients (20 males, 16 females) presented in 2004-2007 (age range 2 days to 14 years; mean 6.2 years). Thirty-seven renal units were included: 13 grade III, 14 grade IV, and 10 grade V injuries. Follow up was for 3-38 (mean 14) months. Patients were managed non-operatively unless vitally unstable. The most common causes of trauma were motor vehicle accidents and falls. Fourteen patients had associated non-renal injuries. Four patients had pre-existing renal problems.
Results:
The surgical intervention group (13 patients, 36%) included 9/10 grade V and 4/14 grade IV renal injuries. Surgical repair of lacerations was performed in seven cases, partial nephrectomy in four cases and nephrectomy in two cases. Follow up showed no significant change in renal function, and none developed hypertension. The non-operative group (24 patients, 63.2%) included all grade III injuries, 10 grade IV injuries, and one grade V injury. There was an excellent outcome for 18/24 patients (75%) with kidney preservation, no complications from urinary extravasation and hematoma resolution. The remaining patients had lower polar infarction (1), renal atrophy (1), persistent subcapsular collection (2), recurrent hematuria requiring angioembolization (1), and there was one death related to central nervous system injury.
Conclusion:
The outcome of our management of pediatric major renal trauma was favorable overall. Longer follow up is needed with regard to renal function and development of hypertension.
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