Introduction
Renal injuries accounts for 8-12% of all pediatric abdominal trauma, of which >90% are blunt and treated conservatively. Questions remain regarding the most adequate follow-up and whether there is a correlation between grade of injury and long-term renal function.
The purposes of this study were to assess the treatment of renal injuries in our institution, evaluate the complications and analyse late functional outcome.
Method
Retrospective review of renal injuries over 22 years in one institution. Patient's demographics, mechanism and grade of injury, associated injuries, management and complications were collected. Consecutive follow-up 123-I-hippuran dynamic renographies (RG) were reviewed and statistical analysis of renal function evolution was assessed.
Results
33 children were identified, consisting of 22 males and 11 females. The mean age was 11.5 years (median 10.6; range 1.5-15.8). All injuries were blunt. There were 2 (6%) grade I, 3 (9%) grade II, 11 (33%) grade III, 9 (27%) grade IV and 8 (25%) grade V. Associated injuries occurred in 24 children. Treatment was surgical in 8, minimal invasive in 15, and non- operative in 13. Complications included 3 urinary infections, 2 hydronephrosis, 14 urinomas, 1 pseudoaneurysm, 1 renal artery thrombosis, 2 calculus and 2 cysts. Chronic hypertension occurred in 3 and chronic renal insufficiency in 2children. Long-term follow-up of renal function consisted of 1 to 8 dynamic renographies (2.9±1.9) over a follow-up period of 1.8 to 16 years (4.6±3.9). Overall long-term function correlated with grade of injury and a trend towards functional loss was observed over time. Detailed renal function analysis will be presented
Conclusion
In our population, the proportion of grade III and above injuries was high when compared to the literature.
The majority of children were treated non-operatively or with minimal invasive procedures. Late occurring clinically significant complications were numerous and warrant long-term clinical and functional follow-up in most cases.