Background: Kidney is the most common site of genitourinary trauma. 50% of all urinary injuries is kidney.Kidney is also affected in 8-12% of all blunt and penetrating trauma to abdomen. 80-90% of renal injury is caused by blunt injury GY. Children, compared to adults, have at a higher risk of renal injury from blunt trauma due to a variety of anatomic factors including decreased perirenal fat, weaker abdominal muscles, and a less ossified thoracic cage. While there are strong trends toward non-operative management of blunt renal trauma, there are no explicit guidelines for high grade injuries. Organ preservation in children is always a primary goal with solid organ injury.
Aim of the work: The aim of the retrospective study is to show the specificity of kidney injury in children as well as the specificity of surgical treatment.
Material and Methods: All 19 patients under the age of 18 who were admitted to Clinic for Pediatic surgery in Sarajevo with a diagnosis of renal trauma were retrospectively reviewed .The Echo an CT were used to identify patients with a renal injury. The time period examined was between January 1, 1999- 2019. Inclusion criteria were either a diagnosis of renal trauma or a diagnosis of blunt abdominal trauma and hematuria. Exclusion criterion was death due to an additional traumatic injury. The mechanism of injury (fall, car accident , assault) injury grade (I-V), the presence of hematuria, and demographic data to include age, weight, and sex, were recorded and reviewed. In addition, amount of blood product required, hematocrit nadir prior to transfusion to assist in ascertaining whether transfusion was necessary, surgical interventions performed, and hospital length of stay were also retrospectively analyzed. Due to the low sample size we used descriptive as opposed to inferential statistics in our analysis.
Result: Demographics include male to female ratio of 13:6 and the average age of patients was 11.9 + 4.6 years. Of the nineteen patients who underwent review, eleven (57,89%) children presented with a grade III renal injury, five with a grade IV injury and three with grade V injury. Six patients presented with gross hematuria and 3 with microscopic hematuria. Only four patients (22%) required blood transfusions, with the average hematocrit nadir being 31 + 5.3% (24.8-37.8). One of the two patients transfused had a concomitant grade IV splenic laceration with a hematocrit nadir of 24.8% and clinical symptoms consistent with shock.
Conclusions:The specificity of the child's anatomy is an aggravating prognostic factor (the kidney is larger in relation to the body cavity than in adults, less protected against the ribs, the muscles of the body and the lower abdomen, the less developed peritoneal and retroperitoneal fatty tissue).It is recommended to initiate conservative treatment (leaching, infusion solution, monitoring) and possibly delayed surgical treatment.Indications for early surgicaly treatment are reserved only for patients with bleeding (absolute) and extravasation (relative).If it is necessary surgical treatment sould be maximally preserve kidney tissue.
Brown SL, Elder JS, Spirnak JP. Are pediatric patients more susceptible to major renal injury from blunt trauma? A comparative study. J Urol. 1998;160(1):138-140.
Miller RC, Sterioff S,Jr, Drucker WR, Persky L, Wright HK, Davis JH. The incidental discovery of occult abdominal tumors in children following blunt abdominal trauma. J Trauma. 1966;6(1):99-106.
Reese JN, Fox JA, Cannon GM,Jr, Ost MC. Timing and predictors for urinary drainage in children with expectantly managed grade IV renal trauma. J Urol. 2014;192(2):512-517.
Gaines BA, Ford HR. Abdominal and pelvic trauma in children. Crit Care Med. 2002;30(11 Suppl):S416-23.
Fitzgerald CL, Tran P, Burnell J, Broghammer JA, Santucci R. Instituting a conservative man¬agement protocol for pediatric blunt renal trauma: evaluation of a prospectively maintained patient registry. J Urol. 2011;185(3):1058-1064.
Henderson CG, Sedberry-Ross S, Pickard R, et al. Management of high grade renal trauma: 20-year experience at a pediatric level I trauma center. J Urol. 2007;178(1):246-50.
Grimsby GM, Voelzke B, Hotaling J, Sorensen MD, Koyle M, Jacobs MA. Demographics of pediatric renal trauma. J Urol. 2014;192(5):1498-1502.
Umbreit EC, Routh JC, Husmann DA. Nonoperative management of nonvascular grade IV blunt renal trauma in children: meta-analysis and systematic review. Urology. 2009;74(3):579-582
Salem HK, Morsi HA, Zakaria A. Management of high-grade renal injuries in children after blunt abdominal trauma: experience of 40 cases. J Pediatr Urol. 2007;3(3):223-229..
Rogers CG, Knight V, MacUra KJ, Ziegfeld S, Paidas CN, Mathews RI. High-grade renal injuries in children--is conservative management possible?. Urology. 2004;64(3):574-579.
Broghammer JA, Langenburg SE, Smith SJ, Santucci RA. Pediatric blunt renal trauma: its conservative management and patterns of associated injuries. Urology. 2006;67(4):823-827.
Nance ML, Lutz N, Carr MC, Canning DA, Stafford PW. Blunt renal injuries in children can be managed nonoperatively: outcome in a consecutive series of patients. J Trauma. 219.
Fuchs ME, Anderson RE, Myers JB, Wallis MC. The incidence of long-term hypertension in children after high-grade renal trauma. J Pediatr Surg. 2015;50(11):1919-1921004;57(3):474-8;.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.