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Pediatric renal injury: which injury grades warrant close follow-up
Lindsey B Armstrong1, David P Mooney2
1Department of Surgery, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
Insights
Children with lower-grade (II-III) renal trauma rarely experience complications and do not require close follow-up. Higher-grade (IV-V) kidney injuries in children warrant monitoring for adverse outcomes and potential interventions.
Area of Science:
- Pediatric Nephrology
- Pediatric Urology
- Trauma Surgery
Background:
- Renal trauma in children can lead to long-term consequences despite most recovering fully.
- Identifying injury grades that necessitate close follow-up is crucial for optimal patient management.
Purpose of the Study:
- To determine which grades of pediatric renal trauma are associated with complications.
- To identify injury grades that warrant close clinical follow-up and monitoring.
Main Methods:
- Retrospective review of pediatric patients with grade II or higher renal injuries over 20 years.
- Analysis of demographics, symptoms, lab values, clinical course, management, and follow-up data.
Main Results:
- 171 children with renal injuries (grades II-V) were analyzed; boys and falls/sports were common.
- No grade II or III renal injuries resulted in intervention or sequelae.
- Grades IV-V injuries were associated with interventions (stenting, surgery, embolization, drainage) and new-onset hypertension in some patients.
Conclusions:
- Pediatric renal injuries grades II and III have a low risk of complications, suggesting routine follow-up may not be necessary.
- Grades IV and V renal injuries present a significant risk for adverse outcomes, necessitating close follow-up and monitoring.
Purpose:
Most children who suffer renal trauma recover fully; however, some have long-term consequences. We sought to determine what grades of injury carry concern for complication and warrant close follow-up.
Methods:
Data on children with grade II or higher renal injuries from a single center over 20 years were reviewed. Demographics, presenting symptoms, lab values, clinical course, management, and follow-up data were analyzed.
Results:
One hundred seventy-one children suffered renal injuries: 75% boys, aged 11.6 ± 3.5 years. Falls-54 and sports-43 were leading injury mechanisms. Presentations included pain only-61, pain and hematuria-28 and hematuria alone-11. Eight had pre-existing abnormalities. Injury grades were: grade II-88 (52%), grade III-49 (29%), grade IV-28 (16%), and grade V-6 (3%). No grades II or III patient underwent intervention or suffered sequelae. Grade IV patients underwent: stenting-5, surgery-2, embolization-1, and drainage-1. Grade V patients underwent: surgery-2, embolization-1, and drain-1. Two grade IV patients underwent late interventions: nephrectomy-1 and stenting-1. Six patients, all grades IV-V, were newly hypertensive at follow-up.
Conclusion:
Grades II and III renal injuries carry a low risk of complication and repeat imaging and close follow-up are likely not necessary. However, grades IV and V injuries carry a meaningful risk of adverse outcome and close follow-up is warranted.
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