Management of kidney injuries in children with blunt abdominal trauma

Background/Purpose: The authors analyzed the incidence and the course of re nal injuries encountered in a cohort of pediatric patients with blunt abdom inal trauma. This review focuses on the early diagnostic and therapeutic ap proach rather than the long-term outcome and draws conclusions for an effec tive initial management. Methods: From 1976 to 1996, the charts of 308 children with blunt abdominal trauma that were admitted to the authors' department were reviewed. The pa tients initially were evaluated using urinalysis, ultrasonography, and abdo minal paracentesis (until 1984) and in specific cases iv-urography, compute d tomography (CT), and angiography. The authors retrospectively classified the renal trauma after the widely used Organ Injury Scaling (OIS) into 5 gr ades and correlated the diagnostic value of various techniques as well as t he diagnostic approach. Results: Sixty-nine serious abdominal traumas were encountered. Thirty-six patients suffered renal lesions grade 2 (G2) or higher; 20 children were po lytraumatized. There were 67 renal lesions including 28 G1, 22 G2, 8 G3, 5 G4, 1 G5, and 3 lesions of the lower urinary tract. Ultrasonography and uri nalysis were found to be the optimal diagnostic methods for screening and f ollowing the course of renal injury, CT scan proved to be most reliable for detecting and exactly classifying renal lesions grade 2 or higher and supe rseded consecutively iv-urography. In cases in which CT scan failed to show renal excretion of contrast agent, angiography was performed. Ten patients proceeded to operative therapy. Conclusions: Ultrasonography and urinalysis proved to be the optimal initia l evaluation tool for excluding renal injury both as a screening method and for further controls. Exact classification was possible by CT scan. During the reviewed time period a shift from surgical to conservative management was notable. If lesions were G4 or G5, surgical treatment with tendency tow ard minimally invasive therapy always was indicated. J Pediatr Surg 35:1326 -1330, Copyright (C) 2000 by W.B. Saunders Company.