title: Management of high-grade renal injury in children.
abstract: BACKGROUND
  The management of severe renal trauma is disputable. Herein, we present diagnosis and treatment of patients with high-grade renal injury (grades IV and V).
  
  
  METHODS
  The records of 31 patients with severe renal trauma who were treated between 2009 and 2014 were analyzed retrospectively. All patients' CT results were evaluated by two radiologists and assigned grades of IV or V in accordance with the American Association for the Surgery of Trauma Organ Injury Severity Scale. All hemodynamically stable renal trauma patients were treated conservatively. Patients with renal traumas of grade IV and V were evaluated statistically via the SPSS 15.0 software program. Chi-square and Mann-Whitney U tests were used to evaluate the categorical data.
  
  
  RESULTS
  Thirteen (42 %) of 31 patients had grade IV, and 18 (58 %) had grade V renal traumas. Twenty-seven (87 %) of the patients had suffered blunt trauma, and four (13 %) had sustained penetrating injuries. Additional organ injuries were seen in 16 patients (52 %), and 15 (48 %) had no concurrent injuries. Twenty-five patients (89 %) were monitored conservatively, three (10 %) underwent surgery, and three patients with grade V renal trauma and additional organ injuries died. There was no statistically significant difference between the grade IV and grade V groups, except in hemoglobin values and the affected kidney (P = 0.07 and P = 0.02, respectively).
  
  
  CONCLUSIONS
  Computerized tomography can help to grade renal injury and assess additional organ injuries quickly. Most children with high-grade renal injury can be managed conservatively. However, conservative management of renal traumas relies on a multidisciplinary approach. Additionally, surgical intervention is generally required in the face of hemodynamic instability or other concurrent organ injuries.
authors.affiliation: Department of Pediatric Surgery, Medical Faculty of Dicle University, 21280, Diyarbakir, Turkey. m.hanifi-okur@hotmail.com.
authors.forename: M H
authors.initials: MH
authors.lastname: Okur
authors.affiliation: Department of Pediatric Surgery, Medical Faculty of Dicle University, 21280, Diyarbakir, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Arslan
authors.affiliation: Department of Pediatric Surgery, Medical Faculty of Dicle University, 21280, Diyarbakir, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Aydogdu
authors.affiliation: Department of Pediatric Surgery, Medical Faculty of Dicle University, 21280, Diyarbakir, Turkey.
authors.forename: M S
authors.initials: MS
authors.lastname: Arslan
authors.affiliation: Department of Radiology, Turkey, Medical Faculty of Dicle University, 21280, Diyarbakir, Turkey.
authors.forename: C
authors.initials: C
authors.lastname: Goya
authors.affiliation: Department of Pediatric Surgery, Medical Faculty of Dicle University, 21280, Diyarbakir, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Zeytun
authors.affiliation: Department of Pediatric Surgery, Medical Faculty of Dicle University, 21280, Diyarbakir, Turkey.
authors.forename: E
authors.initials: E
authors.lastname: Basuguy
authors.affiliation: Department of Pediatric Surgery, Medical Faculty of Dicle University, 21280, Diyarbakir, Turkey.
authors.forename: I
authors.initials: I
authors.lastname: Uygun
authors.affiliation: Department of Pediatric Surgery, Medical Faculty of Dicle University, 21280, Diyarbakir, Turkey.
authors.forename: M K
authors.initials: MK
authors.lastname: Çigdem
authors.affiliation: Department of Pediatric Surgery, Medical Faculty of Dicle University, 21280, Diyarbakir, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Önen
authors.affiliation: Department of Pediatric Surgery, Medical Faculty of Dicle University, 21280, Diyarbakir, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Otcu
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000628:therapy*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D000072700:Conservative Treatment; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D007668:Kidney / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000628:therapy*; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging / Q000628:therapy*
keywords: Children; High grade; Non-surgical management; Severe renal trauma
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