小児腎外傷サバイバーにおける外傷後高血圧：集団ベースのコホート研究

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.

Patients aged 0-21 years who sustained blunt renal trauma from 1976-2024 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.

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=.014), with a higher risk of developing hypertension (HR 2.60, 95% CI 1.18-5.74; p=.018).

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.

Prognostic and Epidemiological; Level III.