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Prolonged dense nephrograms in battered children. Suspect rhabdomyolysis and myoglobinuria
Insights
Child abuse can cause kidney injury, leading to prolonged, dense nephrograms on imaging. This suggests myoglobinuria, which improves with fluid and electrolyte management.
Area of Science:
- Pediatric Nephrology
- Radiology
- Forensic Pediatrics
Background:
- Child abuse can lead to various injuries, including renal trauma.
- Intravenous urography is a diagnostic tool for evaluating renal function and structure.
Observation:
- Five cases of child abuse presented with possible renal injury.
- Oliguria, elevated muscle enzymes, and pigmented, blood-positive urine without red cells were noted.
Findings:
- Prolonged, dense nephrograms on intravenous urography were observed.
- These findings are suggestive of myoglobinuria, a condition not previously emphasized in child abuse.
- Abnormalities resolved with fluid and electrolyte management.
Implications:
- Dense nephrograms on IVU may indicate myoglobinuria secondary to child abuse.
- Early recognition and management can improve outcomes for affected children.
- This highlights the importance of considering child abuse in cases with unexplained renal findings.
Abstract:
Prolonged, dense nephrograms were seen on intravenous urography in 5 cases of child abuse presenting with possible renal injury. Each child had oliguria, elevated muscle enzymes, and pigmented urine positive for blood, but without red cells on microscopic examination. These findings are suggestive of myoglobinuria. The abnormalities resolved with appropriate fluid and electrolyte management. This complication of child abuse, not previously emphasized, may be suggested by the urographic findings. Possible factors contributing to the dense nephrograms are presented.