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Published on: February 2, 2021
A retrospective study of pediatric renal trauma: A single-center experience in Japan
Sarayut Kanjanatarayon1,2, Mimu Ishikawa1, Naoya Tomomasa1
1Division of Pediatric Urology, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan.
Insights
Nearly 40% of pediatric renal trauma cases in Japan did not fit the JAST classification. A new pediatric renal injury scale is needed for better diagnosis and treatment of kidney injuries.
Area of Science:
- Pediatric surgery
- Urology
- Trauma care
Background:
- Pediatric renal trauma management requires accurate injury classification.
- The Japanese Association for the Surgery of Trauma (JAST) classification 2008 is used for grading renal injuries.
Purpose of the Study:
- To analyze pediatric renal trauma cases treated at a Japanese national center.
- To evaluate the applicability of the JAST classification 2008 in pediatric renal trauma.
Main Methods:
- Retrospective review of 45 pediatric patients with renal trauma (2004-2021).
- Data collected on injury causes, treatments, complications, and JAST classification.
- Cases not classifiable by JAST were assigned to a novel 'type 0' category.
Main Results:
- Blunt trauma was universal, primarily from falls and traffic accidents.
- 37.8% of cases were unclassifiable by JAST (type 0), including congenital anomalies (0c) and isolated hematuria (0h).
- Common treatments included blood transfusion and ureteral stenting; complications involved pseudoaneurysm and hypertension.
Conclusions:
- The JAST classification 2008 is insufficient for nearly 40% of pediatric renal trauma cases.
- A dedicated pediatric renal injury scale is necessary for precise diagnosis and treatment.
- Further research is required to develop and validate such a scale.
Objectives:
To report pediatric renal trauma experiences at the National Center for Child Health and Development in Japan according to the Japanese Association for the Surgery of Trauma (JAST) classification 2008.
Methods:
Medical records were retrospectively reviewed for 45 children younger than 18 years old diagnosed with renal trauma from February 2004 to December 2021, regarding details of external causes, treatments, complications, and injury scales according to the JAST classification 2008. The cases who cannot be classified into the JAST classification 2008 will be categorized into our original type 0.
Results:
There were 24 males and 21 females with a mean age of 8.5 years. Left kidneys were the predominantly affected side. Blunt injury was involved in every case (mainly falls and traffic accidents). Concomitant organ injuries were found in 13 cases. The injury scales were type Ia (13.3%), II (11.1%), IIIa (13.3%), IIIb (24.4%). Type 0 accounted for 37.8%, which were type 0c (congenital anomalies of the kidney and urinary tract without hematoma and/or laceration of kidney parenchyma) at 11.1% and type 0h (only hematuria and normal radiologic finding) at 26.7%. Treatments were blood transfusion, ureteral stenting, nephrostomy, and no nephrectomy. Complications were pseudoaneurysm, hypertension, and infection.
Conclusions:
Nearly 38% of cases cannot be classified into the JAST classification 2008, comprising at least two irrelevant types (type 0c and type 0h ). Accordingly, a pediatric renal injury scale should be established to achieve the precise diagnosis and treatments. However, further studies are still needed.
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