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Blunt renal trauma-induced hypertension in pediatric patients: a single-center experience
Marios Marcou1, Matthias Galiano2, Jörg Jüngert2
1Clinic of Urology and Pediatric Urology, University Hospital Erlangen, Germany.
Insights
Pediatric blunt renal trauma can lead to hypertension, sometimes years later. Monitoring blood pressure is crucial, and nephrectomy can cure hypertension in cases of kidney damage.
Area of Science:
- Pediatric Nephrology
- Trauma Surgery
- Hypertension Research
Background:
- Children have a higher risk of renal injury and high-grade injuries compared to adults.
- Hypertension is a rare but serious complication of blunt renal trauma, particularly in major trauma cases.
Purpose of the Study:
- To investigate pediatric blunt renal trauma-induced hypertension.
- To understand the characteristics and outcomes of hypertension following blunt renal trauma in children.
Main Methods:
- Retrospective review of children under 18 with blunt renal trauma over 20 years.
- Analysis of cases with post-traumatic hypertension, focusing on injury type and blood flow reduction.
Main Results:
- 18% of children with blunt renal trauma developed hypertension.
- Hypertension was linked to reduced kidney blood flow from renal artery injury or Page kidney.
- Hypertension onset varied from initial hospitalization to years post-trauma; nephrectomy resolved it in some cases.
Conclusions:
- Post-traumatic hypertension in children can manifest heterogeneously, with delayed onset.
- Children may have a higher risk of renal artery injury and subsequent hypertension.
- Close blood pressure monitoring is vital; nephrectomy can be curative for hypertension due to poorly functioning kidneys.
Purpose:
Children have a greater chance of sustaining a renal injury than adults and higher odds of having a high-grade renal injury. Hypertension is a rare complication of blunt renal trauma, with risk being higher in cases of major renal trauma. We reviewed the cases of pediatric blunt renal trauma-induced hypertension in our tertiary referral center in an attempt to better understand this rare condition.
Study Design:
A retrospective evaluation of children under the age of 18 who were admitted to our department during the last 20 years and were diagnosed with blunt renal trauma.
Results:
Twenty-three children presented with blunt renal trauma, one of whom was treated with emergency nephrectomy. Four children (18%) developed post-traumatic hypertension. All four cases were associated with a reduction in blood flow to the kidney, either through injury to the renal artery (in three cases) or through extrinsic compression of the kidney by a large perirenal hematoma (Page kidney; in one case). The Page kidney case developed hypertension during the initial hospitalization, and it resolved spontaneously after five months through the gradual resorption of the perirenal hematoma. Among the three cases of renal artery injury, hypertension during the initial hospitalization was only observed in one case, with hypertension in the other two cases manifesting after two months and four years, respectively. All three cases of renal artery injury resulted in a complete loss of function of the injured kidney, and two cases were treated with nephrectomy. Following nephrectomy, the blood pressure level returned to normal within a few days.
Discussion:
Development of hypertension following a blunt renal trauma can be heterogenous, with the time of manifestation stretching between days after the accident and years thereafter. Children have a higher risk of renal trauma and, according to published data out of the National Trauma Data Bank, a 20-times higher risk of renal artery injury in comparison to the adult population. Large multicenter studies are required to answer the question of whether children are therefore more prone to blunt renal trauma-induced hypertension than adults.
Conclusions:
Our study highlights the importance of blood pressure monitoring in children following blunt renal trauma, as post-traumatic hypertension can develop even years after the accident. In cases of a poorly functioning kidney, nephrectomy may be regarded as a curative therapy.
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