title: Renal tumor and trauma: a pitfall for conservative (correction of conversative) management.
abstract: OBJECTIVE
  Conservative management has been largely used for renal trauma. Although this approach is safe and highly recommended, it can hide a pre-existing unknown condition, such as tumors or urinary malformations. A high index of suspicion is needed for early recognition of these conditions. We present four cases treated at the Pediatric Oncology Institute - Federal University of São Paulo, which have been initially treated conservatively for renal trauma.
  
  
  METHODS
  We reviewed all 218 renal cases of renal tumors treated at our institution in a 22-year period, searching for associated trauma events.
  
  
  RESULTS
  Four cases of renal tumors were initially treated conservatively for blunt renal trauma of low energy mechanism. Patients ' ages ranged from 7 to 12 years old. Two patients had no previous symptoms, one patient had hematuria and another had an abdominal mass. Computerized Axial Tomography (CT) of the abdomen revealed disparate magnitude of the renal bleeding to the low energy mechanism of trauma. All patients underwent surgical treatment. Kidney specimens showed Wilms tumor in three cases and renal carcinoma in one.
  
  
  CONCLUSIONS
  The association between renal tumors and trauma should be suspected when renal trauma hemorrhage on abdominal CT scan does not match the low energy mechanism of blunt abdominal trauma. The key for a successful diagnosis of renal tumor or congenital malformations is the high index of suspicion for these conditions.
authors: Surgery Department, Federal University of São Paulo, Paulista School of Medicine, São Paulo, Brazil. simoneabib@uol.com.br
authors: Simone de Campos
authors: Sde C
authors: Vieira Abib
authors: Mila Torii Corrêa
authors: MT
authors: Leite
authors: Rodrigo Chaves
authors: RC
authors: Ribeiro
authors: Camila Girardi
authors: CG
authors: Fachin
authors: Maris Salete
authors: MS
authors: Demuner
authors: Monica
authors: M
authors: Cypriano
authors: Sérgio Tomaz
authors: ST
authors: Schettini
mesh_terms: D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D002648:Child; D019468:Disease Management; D005260:Female; D006801:Humans; D007668:Kidney / Q000293:injuries*; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D009396:Wilms Tumor / Q000473:pathology / Q000601:surgery*