title: Natural history of non-operative treatment for renal injuries in children.
abstract: OBJECTIVE
  Kidney is one of the solid organs injured in blunt abdominal traumas. Conservative management is well recognized in adults, but is still controversial in children. We performed a retrospective review regarding children with renal injuries observed at our Centre, analyzing the importance of a prompt diagnosis and the role of conservative treatment according to the degree of renal injury and natural history.
  
  
  METHODS
  We reviewed 15 cases of blunt abdominal trauma with renal injuries observed during a period of 11 years. The diagnosis was confirmed by abdominal computed tomography (CT) scan and ultrasonography (US). Conservative treatment started monitoring the hemodynamic stability, the hematocrit value, the hemoglobin, the red cell count, the urine analysis. If necessary blood transfusion was performed. A follow-up from 1 month to 2 years monitored the lesions healing.
  
  
  RESULTS
  Age of patients varied from 3 to 15 years (mean age = 6.3). Nine were males and six females. Two patients had an associated spleen lesion, thirteen had an isolated renal injury. Injury grades were classified as follows: grade I, 5 cases; grade II, 3 cases; grade III, 5 cases and grade IV, 2 cases. Non operative management was successful in 14 out of 15 cases; 1 patient with grade IV required a partial nephrectomy. At follow-up good healing of the lesions was observed.
  
  
  CONCLUSIONS
  Most of renal injury related to abdominal trauma can be successfully and safely managed conservatively. Hemodynamic stability, a prompt clinical and instrumental diagnosis and grading of lesions by CT are necessary to start an effective non operative treatment.
authors.affiliation: Unit of Pediatric Surgery, Department of Medical and Surgical Pediatric Sciences, University of Messina, Messina, Italy. impellizzerip@unime.it
authors.forename: P
authors.initials: P
authors.lastname: Impellizzeri
authors.forename: F A
authors.initials: FA
authors.lastname: Borruto
authors.forename: G
authors.initials: G
authors.lastname: Scalfari
authors.forename: F
authors.initials: F
authors.lastname: Arena
authors.forename: P
authors.initials: P
authors.lastname: Antonuccio
authors.forename: E
authors.initials: E
authors.lastname: Santacaterina
authors.forename: A S
authors.initials: AS
authors.lastname: Montalto
authors.forename: C
authors.initials: C
authors.lastname: Romeo
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D015601:Injury Severity Score; D007668:Kidney / Q000293:injuries*; D008297:Male; D008991:Monitoring, Physiologic; D009104:Multiple Trauma / Q000175:diagnosis / Q000628:therapy; D009392:Nephrectomy; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*