title: Major renal injuries in children: the real incidence of kidney loss.
abstract: 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.
authors.affiliation: Department of Pediatric Surgery, Hôpital Timone-Enfants, Marseille, France.
authors.forename: Arnauld
authors.initials: A
authors.lastname: Delarue
authors.forename: Thierry
authors.initials: T
authors.lastname: Merrot
authors.forename: Ahmad
authors.initials: A
authors.lastname: Fahkro
authors.forename: Pierre
authors.initials: P
authors.lastname: Alessandrini
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Guys
mesh_terms: 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