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Post-injury hypertension in pediatric renal trauma survivors: A population-based cohort study
Matthew T Parrish1, Swathi Raikot1, Amy Glasgow2
1Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Insights
Children with blunt renal trauma face a higher risk of developing hypertension over time compared to their uninjured peers. Long-term monitoring is crucial for these patients to manage potential hypertension after kidney injury.
Area of Science:
- Pediatric Nephrology
- Trauma Surgery
- Epidemiology
Background:
- Hypertension after childhood blunt renal trauma is not well understood due to limited data.
- Characterizing this condition is vital for effective pediatric aftercare.
- This study investigates hypertension incidence in a population-based cohort of children with blunt renal trauma.
Purpose of the Study:
- To determine if children with blunt renal trauma have a higher incidence of hypertension compared to uninjured controls.
- To characterize the long-term risk of hypertension following blunt renal injury in children.
Main Methods:
- A population-based registry identified patients aged 0-21 years with blunt renal trauma (1976-2024).
- Renal injury severity was graded (AAST or radiologist).
- Hypertension incidence was compared to matched uninjured controls using survival analysis (Kaplan-Meier, Log-Rank, Cox regression).
Main Results:
- 116 patients with blunt renal trauma were analyzed; median follow-up was 12 years.
- Injured patients showed a significantly higher incidence of hypertension at 5 and 20 years post-injury (4% vs 1%; 18% vs 7%; p=.014).
- Blunt renal trauma increased the risk of developing hypertension (Hazard Ratio 2.60, p=.018).
Conclusions:
- The incidence of hypertension increases over time in children with blunt renal trauma.
- This incidence surpasses that of uninjured matched controls.
- Long-term follow-up is essential for children who have sustained blunt renal trauma.
Background:
Hypertension following childhood blunt renal trauma is poorly understood due to limited, single-institution data with variable follow-up. Characterization is essential to determine appropriate aftercare for injured children. We hypothesized that the incidence of hypertension is greater among individuals who sustained blunt renal injury than in uninjured controls in a population-based cohort.
Methods:
Patients aged 0-21 years who sustained blunt renal trauma from 1976 to 2024 who survived to discharge were identified from a population-based registry. Renal injury was identified via AAST renal injury grade or retrospectively graded by a radiologist if missing. The incidence of hypertension (documented diagnosis or prescription of treatment) was compared to a cohort of date, sex, age, and tobacco history-matched uninjured controls using Kaplan Meier, Log-Rank and Cox proportional hazard regression analysis.
Results:
There were 116 patients who sustained blunt renal injury with a median (IQR) age of 16 (14-18) years; 62 % were male, median follow-up was 12 (5-19) years, and grade 3 (n = 34, 29 %) followed by grade 4 (n = 30, 26 %) injures were most common. Most were unilateral injuries (n = 95, 82 %) and were managed nonoperatively (n = 104, 90 %). Compared to uninjured controls, injured patients had greater incidence of hypertension at 5- and 20-years post-injury (4 % vs 1 %, 18 % vs 7 % respectively; p = 0.014), with a higher risk of developing hypertension (HR 2.60, 95 % CI 1.18-5.74; p = 0.018).
Conclusion:
The incidence of post-injury hypertension increased over time in children who sustained blunt renal trauma, exceeding that of uninjured matched controls. This highlights the need for long-term follow-up in this population.
Level Of Evidence:
Prognostic and Epidemiological; Level III.
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