Contemporary management of pediatric renal trauma

Management of pediatric renal trauma has evolved in the past decade to lean towards a conservative approach. This review aims to highlight new findings in imaging utilization, nonoperative management strategies, and postinjury surveillance considerations to optimize patient outcomes and long-term renal preservation.

In hemodynamically stable patients, nonoperative management remains the standard of care, with high success rates. Even among high-grade injuries, most patients are successfully managed without surgery, supporting a renal preservation approach. Gross hematuria remains a significant and independent predictor for need of operative intervention in high-grade injuries, necessitating a thorough imaging evaluation with excretory phase computed tomography (CT) imaging. Emerging imaging modalities such as contrast-enhanced ultrasound show promise in detecting high-grade renal injuries while reducing the use of radiation. The majority of patients do not require repeat imaging, despite recommendations in adult trauma literature, and repeat imaging during admissions should be based on clinical deterioration and symptomatology. Routine yearly blood pressure measurements should be considered for monitoring of renal function decline.

Ongoing refinement of imaging strategies and risk stratification tools holds promise for improving outcomes while reducing unnecessary interventions. Future multicenter, prospective studies are needed to validate these approaches and create standardized care pathways.