Pediatric renal injury: which injury grades warrant close follow-up
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Most children who suffer renal trauma recover fully; however, some have long-term consequences. We sought to determine what grades of injury carry concern for complication and warrant close follow-up.
Data on children with grade II or higher renal injuries from a single center over 20 years were reviewed. Demographics, presenting symptoms, lab values, clinical course, management, and follow-up data were analyzed.
One hundred seventy-one children suffered renal injuries: 75% boys, aged 11.6 ± 3.5 years. Falls-54 and sports-43 were leading injury mechanisms. Presentations included pain only-61, pain and hematuria-28 and hematuria alone-11. Eight had pre-existing abnormalities. Injury grades were: grade II-88 (52%), grade III-49 (29%), grade IV-28 (16%), and grade V-6 (3%). No grades II or III patient underwent intervention or suffered sequelae. Grade IV patients underwent: stenting-5, surgery-2, embolization-1, and drainage-1. Grade V patients underwent: surgery-2, embolization-1, and drain-1. Two grade IV patients underwent late interventions: nephrectomy-1 and stenting-1. Six patients, all grades IV–V, were newly hypertensive at follow-up.
Grades II and III renal injuries carry a low risk of complication and repeat imaging and close follow-up are likely not necessary. However, grades IV and V injuries carry a meaningful risk of adverse outcome and close follow-up is warranted.
KeywordsRenal injury Pediatric Outcome Injury grade Follow-up
This study was unfunded.
Compliance with ethical standards
Conflict of interest
The authors have no real or potential conflicts of interest to disclose.
This article does not contain any studies with human participants or animals performed by any of the authors.
This data review was determined by our IRB to be exempt from any requirement to obtain informed consent from the involved patients.