A need for reevaluation of sports participation recommendations for children with a solitary kidney

PURPOSE: We sought to evaluate the incidence and outcome of blunt renal injury in children by mechanism of injury. These data could then be used to provide the basis for more rational recommendations to parents and physicians regarding participation in sporting activities. MATERIALS AND METHODS: We analyzed data on 49,651 pediatric trauma cases collected by 92 trauma centers as part of the National Pediatric Trauma Registry from 1995 to 2001. Cases involving renal injury were isolated and the data were stratified according to age, sex and injury, as well as procedures required for treatment and outcomes. RESULTS: Of 49,651 pediatric trauma patients 813 incurred renal injury. There were 516 males and 291 females, and sex was not documented in 6 children. Average age was 10.6 years. There were no reports of a solitary kidney. In the sports group there were 4 nephrectomies, which were associated with sledding (2), skiing (1) and rollerblading (1), and 2 deaths related to skiing (1) and jet skiing (1). All 3 nephrectomies in the nonsports/other group were associated with equestrian activities, and 1 death occurred in this population. The nonsports/other group includes minor sports that are outlined by the American Academy of Pediatrics Committee on Sports Medicine and Fitness. CONCLUSIONS: The majority of renal injuries in children associated with kidney loss (21 of 28) occurred as a result of motor vehicle accidents, pedestrians being struck by a vehicle or other object, and falls. There were no kidneys lost in any contact sport. Sledding, skiing and rollerblading resulted in kidney loss. Current recommendations of the American Academy of Pediatrics Committee on Sports Medicine and Fitness prohibiting children with a solitary kidney from participating in contact sports appear to be overly protective and need to be reevaluated. In some instances activities listed as limited contact sports resulted in renal loss, showing that the risk associated with these activities has been underestimated.