Related Experiment Video
Updated: Mar 16, 2026
Noninvasive and Invasive Renal Hypoxia Monitoring in a Porcine Model of Hemorrhagic Shock
Published on: October 28, 2022
[Management of blunt renal trauma in paediatric patients]
L Brouwers1, M Bemelman, W L M Kramer
1Elisabeth-TweeSteden Ziekenhuis, afd. Chirurgie, Tilburg.
Insights
Blunt abdominal trauma frequently causes injuries to abdominal organs in children. Prompt renal imaging is crucial for persistent hematuria, guiding conservative or surgical management based on hemodynamic stability.
Area of Science:
- Pediatric Traumatology
- Nephrology
- Emergency Medicine
Background:
- Blunt abdominal trauma is a common cause of injury to renal, splenic, or hepatic organs in 90% of pediatric cases.
- Children's kidneys are less protected, increasing susceptibility to injury from direct flank trauma (e.g., handlebars, knees).
- Recognizing signs like flank hematoma, 'seatbelt-sign', gross hematuria, and associated fractures is vital for identifying potential renal trauma.
Purpose of the Study:
- To outline diagnostic and management strategies for pediatric blunt renal trauma.
- To emphasize the importance of imaging in cases of persistent hematuria, regardless of severity.
- To differentiate management protocols based on patient hemodynamic status and injury grade.
Main Methods:
- Clinical assessment for signs and symptoms of renal trauma.
- Doppler ultrasound for initial evaluation of renal abnormalities.
- Renal imaging (e.g., CT scan) for persistent hematuria.
- Management based on hemodynamic stability and injury grading (using American Association for the Surgery of Trauma - Blunt Abdominal Trauma scale).
- Follow-up DMSA scan for high-grade injuries (IV-V).
Main Results:
- Hematuria does not reliably correlate with renal injury severity.
- Children with normal Doppler ultrasound and no gross hematuria can be safely discharged.
- Conservative management is suitable for hemodynamically stable patients; urgent laparotomy is required for unstable patients.
- Bed rest is reserved for Grade V renal injuries.
- DMSA scans are recommended for Grade IV-V injuries 6-12 weeks post-trauma.
Conclusions:
- Prompt and appropriate renal imaging is essential for pediatric blunt abdominal trauma, especially with persistent hematuria.
- Management should be tailored to hemodynamic stability and injury severity.
- Conservative treatment is effective for most stable pediatric blunt renal trauma cases, with surgical intervention reserved for unstable patients.
Abstract:
- In 90% of children, blunt abdominal trauma is the cause of renal, splenic or hepatic injury or an injury affecting a combination of these organs.- Because children's kidneys are anatomically less protected than those of adults, potential renal injury following direct trauma affecting the child's flank, for example by a handlebar or knee should be considered.- Symptoms of renal trauma include excoriations or haematoma on the flank, a 'seatbelt-sign', macroscopic haematuria and fractures of the ribs and vertebra.- As haematuria does not correlate with the severity of renal injury, all children with persistent haematuria should undergo renal imaging.- Children without abnormalities on Doppler ultrasound examination and without macroscopic haematuria can be discharged from the emergency room.- Conservative management of blunt renal trauma is indicated for all haemodynamically stable children. However, haemodynamically unstable children need to undergo an urgent laparotomy. The routine use of bed rest is only indicated for grade V renal injuries.- A DMSA scan is recommended 6-12 weeks after trauma for grade IV-V renal injury.
Related Concept Videos
01:20Acute Kidney Injury V: Interprofessional Care
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:28Urinary Tract Calculi V: Nursing Management
01:25Urinary Tract Calculi VI: Surgical Management
01:30Urinary Tract Calculi III: Medical Management
01:22Acute Kidney Injury I: Introduction