1 / 16

Renal Trauma

Renal Trauma . George W. Holcomb, III, M.D., MBA Surgeon-in-Chief Children’s Mercy Hospital Kansas City, MO. Renal Trauma. Trauma is most common cause of death in children Injuries to the kidneys account for 60% of genitourinary injuries 90% blunt trauma Usually do not require operation

arnie
Download Presentation

Renal Trauma

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Renal Trauma George W. Holcomb, III, M.D., MBA Surgeon-in-Chief Children’s Mercy Hospital Kansas City, MO

  2. Renal Trauma • Trauma is most common cause of death in children • Injuries to the kidneys account for 60% of genitourinary injuries • 90% blunt trauma • Usually do not require operation • 10-20% penetrating trauma • More often require operation • Deceleration/flexion injuries • Produce renal arterial or venous injuries

  3. Renal Trauma • Due to their size and location, kidneys are susceptible to injury from blunt trauma • Children are more susceptible than adults to major renal injury • Less perirenal fat • Weaker abdominal musculature • Less well-ossified thoracic cage • Kidneys with congenital abnormalities are at increased risk of injury • Pediatric evaluation and treatment guidelines not clearly defined for children

  4. Renal Trauma • Standard Imaging Modality – (U.S.) • CT scan often performed in trauma w/u • CT scan recommended in patients with hematuria • Ultrasound may be used to screen hemodynamically unstable patients • FAST 95% specificity, but 33-89% sensitivity

  5. Renal Trauma • Management goal: renal salvage • Indications for immediate exploration • Hemodynamic instability • Penetrating injury – unstable patient • Associated non-renal injuries • Nephrectomy required in less than 10% of cases • Isolated penetrating renal injury in stable patient can be managed conservatively • Aggressive radiologic, laboratory and clinical efforts important in managing patients w/o operation

  6. American Association for the Surgery of Trauma Injury Scale

  7. Renal Trauma • Stable grade I-III injuries • Managed non-operatively • Severe grade IV-V • Require careful selection based on • hemodynamic stability • mechanism • associated non-renal injuries • Stable patients may need monitoring in ICU setting

  8. Renal Trauma • Management • Inconclusive data • Antibiotics • Likely only needed when stent placed • Bedrest • Variable practice: bedrest for 5-7 days, or until hematuria clears, or once physically able • No consensus

  9. Renal Trauma • Management • Ureteral stent indications • 80% of grade IV and V collecting system injuries heal without intervention • If collecting system extravasation does not resolve within two weeks, stenting is then considered • Symptomatic urinomas may require stenting • Lack of contrast in ipsilateral ureter may indicate significant injury, necessitating stent

  10. Renal Trauma • Complications • Hypertension • Estimated incidence: 0 - 7.5% • Follow-up imaging • Little data to support its use

  11. J PediatrSurg 45:1311-1314, 2010

  12. Children’s Mercy1995 - 2007 • All patients with blunt renal trauma • Mean age 11 yrs • MVC - 44% • Falls - 30% • Sports - 22% • Grade I - 26% Grade II - 23% Grade III - 35% Grade IV - 13% Grade V - 3% J PediatrSurg 45:1311-1314, 2010

  13. Children’s Mercy • Isolated renal injury - (44%) • Bed rest - 3.8 ± 1.9 d (mean) • Hospital - 3.8 ± 3.1 d (mean) • Blood tx – 15 pts • Mean vol – 700 c • Op – 6 pts – None for renal injury • No tx in isolated renal injury • No tx Grade IV or V injury • Renal salvage – 99.1% • One nephrectomy in pt w/ESRD • HTN – 3 pts – 1 resolved • Urinoma – 1 pt – resolved w/drainage J PediatrSurg 45:1311-1314, 2010

  14. Renal Trauma • CMH is currently participating in multi-institutional, prospective, randomized trial with long-term follow-up • Patients allowed out of bed when physically able • Daily UA while in hospital • Once discharged, weekly UA until hematuria is cleared • Discharged when patients meet general discharge criteria • 3 year follow-up for hypertension

  15. References • Fraser, JD, Aguayo P, Ostlie DJ, et al: Review of the evidence on the management of blunt renal trauma in pediatric patients. Pediatr Surg Int (2009) 25:125-132. • Holcomb GW III, Murphy JP. Ashcraft’s Pediatric Surgery. 5th ed. Philadelphia, PA: Saunders An Imprint of Elsevier, 2010. • Nerli RB, Metgud T, Patil S, et al: Severe renal injuries in children following blunt abdominal trauma: selective management and outcome. Pediatr Surg Int (2011) 27:1213-1216 • Suson KD, Gupta AD, Wang MH. Bloody urine after minor trauma in a child: isolated renal injury versus congenital anomaly? J Pediatr. (2011) 159:870.

  16. QUESTIONS www.cmhclinicaltrials.com

More Related