Nonoperative management of blunt renal injury: a need for further study

Background

Blunt renal injury in children is usually managed without an operation. However, there are no published guidelines for nonoperative management. Therefore, we conducted a retrospective review to examine the natural history of these injuries and to identify potential recommendations for management.

Methods

A retrospective analysis of our most recent 12-year experience with blunt renal injury was performed.

Results

One hundred eleven trauma patients were identified as having a renal injury. Mean age was 10.8 ± 4.4 years with a weight of 43.1 ± 20.8 kg and 65% of the patients were males.In patients with an isolated renal injury (n = 65), the mean length of bed rest was 3.8 ± 1.9 days, resulting in a mean length of hospitalization of 3.8 ± 3.1 days. There were no transfusions, and the only operation for renal trauma was a nephrectomy in a patient with existing end-stage obstructive nephropathy of that kidney.There were 15 patients discharged with persistent hematuria, none of which had long-term sequelae.

Conclusion

Our data suggest the risk of significant injury from blunt renal trauma is low, and clearance of hematuria is not likely an important parameter such that bed rest with serial blood and urine monitoring may not be justified. There is clearly a role for the prospective application of a more liberal management protocol.