Pediatric renal trauma.

OBJECTIVES: To review the pediatric renal trauma cases during the past 10 years to determine the appropriate indications for imaging and operative intervention.
METHODS: We searched the medical records from 1989 to 1999 and identified 61 patients aged up to 18 years old with objective data on renal trauma grade by either computed tomography or operative exploration and analyzed the data.
RESULTS: Of the 61 cases, 46 were blunt and 15 were penetrating injuries. Thirty-two (70%) of 46 patients with blunt injuries and all 15 patients (100%) with penetrating injuries sustained significant grade 2-5 injuries. The 14 grade 1 blunt injuries included 4 (29%) with gross hematuria, 7 (50%) with microscopic hematuria, and 3 (21%) with normal urinalyses. The 32 grade 2-5 blunt injuries included 20 (63%) with gross hematuria, 8 (25%) with microscopic hematuria, and 4 (13%) with normal urinalyses. The 15 grade 2-5 penetrating injuries included 9 (60%) with gross hematuria, 2 (13%) with microscopic hematuria, and 4 (27%) with normal urinalyses. Five of the blunt (11%) and 13 of the penetrating (87%) injuries were managed with renal operative intervention, including 12 repairs of lacerations or vessel injuries and 6 nephrectomies.
CONCLUSIONS: Renal injuries of significant grade were encountered that presented with microscopic hematuria, as well as with normal urinalysis findings. Therefore, the decision for renal imaging for the diagnosis and grading of renal injuries should not be based on urinalysis alone in isolation from clinical status, history, and mechanism of injury. Although the vast majority of renal injuries do not require surgical intervention, their accurate grading prompts treatment with surveillance, bed rest, and close in-hospital monitoring.