title: Management of Pediatric Grade IV Renal Trauma.
abstract: OBJECTIVE
  Review the current literature regarding the management of grade IV renal injuries in children.
  
  
  RESULTS
  Children are at increased risk for renal trauma compared to adults due to differences in anatomy. Newer grading systems have been proposed and are reviewed. Observation of most grade IV renal injuries is safe. Operative intervention is necessary for the unstable patient to control life-threatening bleeding with either angioembolization or open exploration. Symptomatic urinomas may require percutaneous drainage and/or endoscopic stent placement. Ureteropelvic junction (UPJ) disruption, seen more often in children, requires immediate surgical repair. Grade IV renal injuries in children are increasingly managed in a conservative manner.
authors.affiliation: Department of Urology, University of California-San Francisco, San Francisco, CA, USA.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Murphy
authors.affiliation: Department of Urology, University of California-San Francisco, San Francisco, CA, USA.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Gaither
authors.affiliation: Department of Urology, University of California-San Francisco, San Francisco, CA, USA.|Department of Surgery, King Abdulaziz University, Rabigh, Saudi Arabia.
authors.forename: Mohannad A
authors.initials: MA
authors.lastname: Awad
authors.affiliation: Department of Urology, Dell Medical School, University of Texas, Austin, TX, USA.
authors.forename: E Charles
authors.initials: EC
authors.lastname: Osterberg
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, USA.
authors.forename: Nima
authors.initials: N
authors.lastname: Baradaran
authors.affiliation: Department of Urology, University of California-San Francisco, San Francisco, CA, USA.
authors.forename: Hillary L
authors.initials: HL
authors.lastname: Copp
authors.affiliation: Department of Urology, University of California-San Francisco, San Francisco, CA, USA. Benjamin.Breyer@ucsf.edu.|Department of Biostatistics and Epidemiology, University of California - San Francisco (UCSF), San Francisco, CA, USA. Benjamin.Breyer@ucsf.edu.|Zuckerberg San Francisco General Hospital and Trauma Center, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA. Benjamin.Breyer@ucsf.edu.
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Breyer
mesh_terms: D002648:Child; D004322:Drainage; D004621:Embolization, Therapeutic; D004724:Endoscopy; D006470:Hemorrhage / Q000628:therapy; D006801:Humans; D007668:Kidney / Q000293:injuries*
keywords: Grade IV laceration; Pediatric; Renal trauma