Pediatric renal injuries: management guidelines from a 25-year experience.
OBJECTIVE
We defined the mechanism and cause of pediatric renal trauma, and developed guidelines for management based on the outcome analysis of operative vs nonoperative management.


METHODS
We retrospectively reviewed 374 pediatric renal injuries at San Francisco General Hospital, comparing operative vs nonoperative management based on clinical presentation, type of renal injury, hemodynamic stability, associated injuries and the results of radiographic imaging.


RESULTS
Blunt trauma accounted for 89% of pediatric renal trauma with a renal exploration rate of less than 2%. Penetrating trauma represented the remaining 11% with a renal exploration rate of 76%. Of grade IV renal injuries 41% were successfully managed nonoperatively based on computerized tomography and staging in hemodynamically stable children. Our overall renal salvage rate was greater than 99%.


CONCLUSIONS
Pediatric renal trauma is often minor and observation poses no significant danger to the child. In serious pediatric renal injuries early detection and staging based on clinical presentation and computerized tomography are critical for determining operative vs nonoperative management. Regardless of the type of management the standard of care is renal preservation (less than 1% nephrectomy rate in this series).
Buckley
Jill C
JC
Department of Urology, University of California School of Medicine and Urology Service, San Francisco General Hospital, USA.
McAninch
Jack W
JW
D000465:Algorithms; D002648:Child; D006417:Hematuria / Q000628:therapy; D006439:Hemodynamics; D006801:Humans; D007668:Kidney / Q000293:injuries*; D022125:Lacerations / Q000628:therapy; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000601:surgery / Q000628:therapy*; D014950:Wounds, Penetrating / Q000601:surgery / Q000628:therapy*