Major renal injuries in children: the real incidence of kidney loss.
BACKGROUND
The prognosis of major renal injuries appears to have improved since a conservative approach has been promoted. The overall prognosis might be less optimistic if all cases are pooled, whatever the type of initial injury (parenchymal or vascular) or the type of treatment (operative or conservative).


METHODS
The records of 32 children were reviewed. Six patients had a vascular injury, and 26 had a parenchymal injury. Ten were operated on within one month after trauma, and 3 (including one previously operated) underwent delayed surgery for sequelae. Parenchymal loss from atrophy was estimated on echography, computerized tomography, or radionuclide scintigraphy.


RESULTS
Fourteen patients (44%) recovered a functioning kidney. Nine (28%: all 6 patients with vascular injury and 3 with parenchymal trauma) lost their kidney from nephrectomy (n = 3) or atrophy (n = 6). Seven patients had severe or moderate sequelae from either partial nephrectomy or partial atrophy. Two had a minimal loss from polar hypotrophy. The incidence of kidney loss or sequelae was 56% (18 of 32 patients).


CONCLUSIONS
In keeping with the literature data provided all cases are analyzed, at least one out of 4 kidneys will be lost or severely damaged after major kidney trauma in children.
Delarue
Arnauld
A
Department of Pediatric Surgery, Hôpital Timone-Enfants, Marseille, France.
Merrot
Thierry
T
Fahkro
Ahmad
A
Alessandrini
Pierre
P
Guys
Jean-Michel
JM
D000293:Adolescent; D001284:Atrophy; D002648:Child; D002675:Child, Preschool; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D007674:Kidney Diseases / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D008297:Male; D009392:Nephrectomy; D009403:Nephrostomy, Percutaneous; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012077:Renal Artery / Q000293:injuries / Q000601:surgery; D012078:Renal Artery Obstruction / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000453:epidemiology / Q000473:pathology / Q000601:surgery