Severe renal injuries in children following blunt abdominal trauma: selective management and outcome.

INTRODUCTION: Blunt trauma accounts for the majority of pediatric renal injuries. Most injuries are often minor and can be managed without surgical intervention. We have retrospectively reviewed our series of children with severe (grade IV/V) renal injuries, their management and outcome.

MATERIALS AND METHODS: Medical records of children less than 18 years with renal injuries were reviewed. The cause of injury, time following injury, management and outcome in these children were recorded. The outcome data were analyzed.

RESULTS: During the period between January 1996 and December 2008, 43 children with grade IV/V renal injuries were admitted with blunt abdominal trauma. Ten of these 43 children underwent exploration and 33 initially managed non-operatively. Two of these 33 children on non-operative management needed nephrectomy for vascular injury and delayed haemorrhage.

CONCLUSIONS: Most children with grade IV/V renal injury following blunt trauma can be managed non-operatively. Management can be properly planned and executed based on clinical features, CT imaging and staging of renal injuries. Surgical intervention is needed for associated abdominal organ injuries and renal vascular injuries.