Conservative Management of Blunt Renal Injury in Children

Renal trauma in the pediatric population is predominately due to the blunt mechanism of injury, and children are more likely to sustain renal injury than adults following blunt abdominal trauma. In children, the kidneys are low in the abdomen, less well protected by the lower ribs, more mobile, have less protective perirenal fat, and are proportionately larger in the abdomen.The kidney is the most commonly injured genitourinary organ in blunt trauma followed by the bladder in both adult and pediatric populations. As in adults, pediatric blunt renal trauma has trended to nonoperative management. The literature lacks definitive data on the management and outcomes of pediatric blunt renal trauma patients. The controversy still exists about the role of conservative management in high-grade injuries. Hemodynamic status, not injury grade, should determine need for operative intervention. Hemodynamic instability or life-threatening renal bleeding should be treated with immediate surgical intervention without delay. We perform CT scan in hemodynamically stablechildren when we suspect intra-abdominal organ injury for blunt trauma. If hemodynamically stable, we believe close observation with nonoperative management for even high-grade injury in the critical care unit is safe. The current guidelines for management of pediatric renal trauma are based on these limited data. There is need for additional studies to support the establishment of evidence-basedrecommendations. Our purpose was to determine the associated injuries, features, incidence, management, and outcomes of kidney injuries resulting from blunt trauma in the pediatric population. Relevant articles and guide lines published between 2001 and 2019 were reviewed in this literature