Renal trauma in children

BACKGROUND: This paper reviews our experience with management of renal injuries in children and adolescents with a focus on the outcome of non-operative management (NOM). METHODS: Retrospective review of the clinical characteristics, injury grade (I-III, low grade and IV and V high grade), management and outcomes of children ≤ 18 years old with renal trauma presenting to a major trauma centre in South Africa between December 2012 and October 2020. RESULTS: Sixty-one children with a renal injury were identified with a median age of 13 (range 0-18) years...

INTRODUCTION: in Brazil, trauma is responsible for 40% of deaths in the age group between 5 and 9 years old, and 18% between 1 and 4 years, and bleeding is the leading cause of preventable death in the traumatized child. Conservative management of blunt abdominal trauma with solid organs injury - started in the 60s - is the current world trend, with studies showing survival rates above 90%. The objective was to assess the efficacy and safety of conservative treatment in children with blunt abdominal trauma treated at the Clinical Hospital of the University of Campinas, in the last five years...

OBJECTIVE: The safety of Low Titer Group O Whole Blood (LTOWB) transfusion has not been well-studied in small children. METHODS: This is a single-center retrospective cohort study of pediatric recipients of RhD- LTOWB (June 2016-October 2022) who weigh less than 20 kilograms. Biochemical markers of hemolysis (lactate dehydrogenase, total bilirubin, haptoglobin, and reticulocyte count) and renal function (creatinine and potassium) were recorded on the day of LTOWB transfusion and post-transfusion days 1 and 2...

Child abuse is a challenging problem that any healthcare worker might encounter. It can lead to multiple physical and psychological effects on the child. We report a case of an eight-year-old boy who presented to the emergency department with history of decreased level of consciousness and change in urine color. On examination, he was found to be jaundiced, pale, and hypertensive (160/90 mmHg) with multiple skin abrasions all over the body, suggestive of physical abuse. Laboratory investigations were consistent with acute kidney injury and significant muscle damage...

AIMS: To describe the aetiologies of paediatric rhabdomyolysis and explore the medium-term renal consequences. METHODS: Retrospective, single-centre review of children with rhabdomyolysis. RESULTS: Two hundred and thirty-two children met inclusion criteria for the analysis. Mean age at presentation was 8.4 (SD ± 5.5) years. The commonest aetiology was infection (28%), with viral myositis making up the clear majority (75%)...

BACKGROUND: Evidence of health disparities for Indigenous children requiring surgical care is lacking. We present a systematic review of the literature examining possible disparities in surgical care and outcomes for pediatric patients of Indigenous ethnicity. DATA SOURCES: PubMed, Cochrane, MEDLINE, gray literature. METHODS: Literature review, using PubMed, Cochrane, MEDLINE, and gray literature was conducted to identify articles published more than 2010-2020 examining children's surgical health service delivery (epidemiology, access, operations provided) and outcomes for pediatric patients of Indigenous ethnicity compared with others...

Introduction: blunt renal traumas in children are rare and their management is not suited to a very clear consensus. We sought to report our experience in managing renal injuries in children presented after blunt abdominal trauma. Methods: data of children aged less than 16 years with blunt renal injuries between January 2015 and April 2021 were retrospectively reviewed. Demographic characteristics, clinical course, biological results, radiological findings, associated injuries, management and follow up of included patients were described...

BACKGROUND: This study reviews the indications and outcome of emergency laparotomy for paediatric trauma in a South African trauma centre. METHODS: This was a retrospective study of all children less than 18 years of age who underwent an emergency laparotomy for trauma between December 2012 and October 2020 at Grey's Hospital in Pietermaritzburg. RESULTS: During the eight-year period under review, a total of 136 children of which 107 were male underwent a laparotomy for trauma...

INTRODUCTION AND OBJECTIVES: Throughout the years, clinicians dealing with pediatric urology disorders have resorted to bladder augmentation (BA), a demanding surgical procedure, to preserve renal functions in sundry congenital urinary tract defects. This study aimed to reveal the very long-term outcomes of BA in a large sample of pediatric patients and the role of underlying disease on renal prognosis after BA. MATERIALS AND METHODS: A retrospective cross-sectional study was conducted on 54 children with congenital urinary defects who underwent BA...

Sickle cell trait (SCT) has historically been considered a benign condition, but SCT-positive patients have increased baseline risk of venous thromboembolism and chronic kidney disease, as well as increased risk of sickled erythrocytes in settings of hypoxia, acidosis, and hypovolemia. Multisystem traumatic injuries are a common clinical scenario, in which hypoxia, acidosis, and hypovolemia occur; however, little is known about how SCT-positive status impacts outcomes in multisystem trauma. We conducted a scoping literature review to investigate what was known about SCT in the setting of multisystem trauma...

INTRODUCTION: Isolated blunt abdominal trauma in children is a rare condition. Pre-existing malformations like ureteropelvic junction (UPJ) obstruction makes the condition a urological dilemma. PRESENTATION OF CASE: A seven-year-old boy presented with blunt abdominal trauma. No significant past medical history. Computed tomography of the abdomen and pelvis showed a right giant hydronephrosis. After which, we performed simple nephrectomy. Pathological study showed neglected hydronephrosis secondary to ureteropelvic junction obstruction...

INTRODUCTION: Clean intermittent catheterization (CIC) is a mainstay in the management of neurogenic bladder. OBJECTIVE: To assess the effect of CIC on urinary tract infection and upper renal tract function in pediatric patients with neurogenic bladder, and the influence of duration of CIC on these variables. STUDY DESIGN: A retrospective study was performed in 67 pediatric patients with neurogenic bladder who started CIC between 2014 and 2019 at our institution...

BACKGROUND: Priapism is a rare condition in children and the treatment algorithm is controversial in this age group. Herein, we report eight cases with low-flow priapism and our stepwise treatment approach in light of literature. METHODS: We present a simple stepwise treatment for low-flow priapism including five steps. Step 1: Cold compress and analgesia while evaluation the priapism and its etiology. Step 2: Corporal aspiration and adrenaline infusion in the ward...

BACKGROUND: Existing studies have found a low prevalence of multiple organ dysfunction syndrome (MODS) in pediatric trauma patients, typically applying adult criteria to single-center pediatric cohorts. We used pediatric criteria to determine the prevalence, risk factors, and outcomes of MODS among critically injured children in a national PICU database. METHODS: We conducted a retrospective cohort study of PICU patients 1 month to 17 years with traumatic injury in the Virtual Pediatric Systems, LLC (VPS) database from 2009-2017...

Background: Renal trauma (RT) is a common feature in children with severe Henoch-Schonlein purpura (HSP), which can elevate the chance of recurrence and trigger end-stage renal disease. The risk factors of RT in children with HSP were explored and research was conducted on relevant treatment methods. Methods: A total of 120 child patients with severe HSP admitted to our hospital from January 2019 to January 2020 were selected as the research cohort, and divided into a RT group (n=45) and RT-free group (n=75) according to their condition to analyze the risk factors inducing RT in pediatric patients, and mycophenolate mofetil therapy was given to both participant groups to compare their renal function indicators, immune function indicators, and adverse reaction rates (ARR) after treatment...

BACKGROUND: Few consensus statements exist to guide the timely diagnosis and management of urine leaks in children sustaining BRT (blunt renal trauma). The aims of this study were to characterize kidney injuries among children who sustain BRT, evaluate risk factors for urine leaks, and describe the negative impact of urinoma on patient outcomes and resource consumption. METHODS: A retrospective review was performed of 347 patients, aged <19 years, who presented with BRT to a single ACS-verified Level I Pediatric Trauma Center between 2005-2020...

INTRODUCTION: AUA Urotrauma guidelines for renal injury recommend initial nonoperative management followed by repeat CT imaging for stable patients with deep lacerations or clinical signs of complications. Particularly in pediatric patients where caution is taken to limit radiation exposure, it is not known whether routine repeat imaging affects clinical outcomes. OBJECTIVE: Our objective was to determine whether routine repeat imaging is associated with urologic intervention or complications in nonoperatively managed pediatric renal trauma...

BACKGROUND: Management algorithms of paediatric blunt abdominal solid organ injury (BASOI) are evolving to include interventional radiology, but there are few studies documenting the application and clinical outcomes of cases in children. METHODS: A retrospective case note review of all paediatric BASOI at a single Paediatric Major Trauma Centre was completed. CT scans and injuries have been retrospectively graded according to AAST guidelines. RESULTS: In the period February 2012 - October 2019, there were 106 children (median age 10...

Nutcracker syndrome (NCS) is an extrinsic compression of the left renal vein (LRV) by the superior mesenteric artery (SMA) anteriorly and aorta posteriorly resulting in renal vascular congestion manifesting as hematuria, proteinuria, orthostatic hypotension, pain, or even renal dysfunction. Long-standing venous compression can encourage collateral drainage pathways through gonadal and pelvic veins, which may explain reported symptom and syndrome overlap with pelvic congestion syndrome. Diagnosis can be challenging and variable, frequently involving a combination of ultrasound Doppler, cross-sectional, and invasive imaging...

INTRODUCTION: Kidneys are the most frequently injured organ in the genitourinary system, but there is no specific biological marker for this trauma. Renalase may be a descriptive biomarker of the pathology that causes renal ischemia, nephrotoxicity, and acute renal failure. OBJECTIVE: This study investigated the role of serum and urine levels of renalase for the diagnosis of renal injury in rats with experimentally induced blunt renal trauma. STUDY DESIGN: Thirty 3-month-old Sprague-Dawley adult male rats were divided into five groups (n = 6) as follows: control (Group 1), sham (Group 2), right nephrectomy (Group 3), left renal trauma (Group 4), and right nephrectomy plus left renal trauma (Group 5)...