PEDIATRIC RENAL TRAUMA - CAUTION WITH CONSERVATIVE MANAGEMENT OF MAJOR INJURIES

Background: The kidney is the most frequently injured abdominal organ in children and controversy surrounds some aspects of management. This study looks at the experience of our institution and reviews the lite rature towards developing an optimal strategy for managing this common childhood injury. Methods: One hundred and forty-two cases of paediat ric renal trauma are reported from a catchment population of approxima tely 240 000 children < 14 pears of age over a 12 year period. Injurie s were classified into four groups: groups 1 and 2 were regarded as mi nor injuries (85%) and group 3 and 4 injuries were those with extravas ation of urine or pedicle injury (15%). Results: The male:female ratio was 2:1 with an average age of 8.5 years. Major renal injuries freque ntly required large amounts of resuscitation fluid. Associated injurie s were present in 41% of all cases with an average of two injuries eac h. With one exception in each case, the development of complications a nd the need for early surgery were confined to major injuries. There w ere no long-term complications. The renal loss rate was 2.1%. Conclusi ons: Renal injuries can be usefully classified into major or minor by determining whether extravasation of urine or pedicle injury is presen t. Minor injuries should be managed conservatively. Major injuries cau sing ongoing haemorrhage require urgent surgery. Other major injuries should be imaged regularly and patients with more severe urinomas bene fit from early elective surgery at 2-5 days. In cases where extravasat ion of urine has not shown clear evidence of settling by 5 days' elect ive surgery probably results in less morbidity and fewer complications than protracted conservative treatment.