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Pediatric Renal Trauma: Which Grades are a "Real" Concern?
Lindsey Bendure Armstrong, MD, Samuel C. Barnett, BS, Mary Arbuthnot, DO, David P. Mooney, MD, MPH. Boston Children's Hospital, Boston, MA, USA.

Background: Single-institution series of pediatric renal trauma are limited by small numbers or the inclusion of low-grade injuries, which have little concern for complications. We sought to determine at what grade of injury concern for complications is warranted.

Methods: The trauma registry of an urban level 1 Pediatric Trauma Center was reviewed and data on children with grade 2 or higher renal injuries were identified from 1994-2014. Demographics and presenting symptoms, vitals, lab values, clinical course, and follow-up were extracted from the registry and patient charts.

Results: 171 children were identified, 75% boys, aged 11.6 3.5 years. Falls (54), Sports (43), Bicycle crashes (27), motor vehicle crashes (18), Pedestrian (11) were the leading mechanisms. 61 children presented with pain, 28 with pain and hematuria and 11 with hematuria. 8 children had pre-existing renal abnormalities: glomerulonephropathy(1), Horseshoe kidney(1), tumor(1), UPJ stenosis(1) and vesicoureteral reflux(4). 68 children had associated injuries including 34 spleen and 11 liver injuries. There were no deaths. 4 children were newly hypertensive at follow-up: 1 resolved without intervention, 1 maintained on medications years later and 2 lost to follow-up. Late operations included two nephrectomies: tumor and UPJ stricture-induced hydronephrosis and repair of pre-existing UPJ stenosis.

Conclusions: Grade 2 and 3 renal injuries carry a low risk of complications. However, grade 4 and 5 injuries have a real chance of long-term problems and close follow-up is warranted.

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