Comparison of short- and long-term functional outcome of nonoperatively managed renal injuries in children

Purpose: The purpose of this study was to better determine the long-term functional outcome of nonoperatively managed renal injuries in children. Methods: After Institutional Review Board approval, all children with blunt renal injuries were retrospectively reviewed. Renal function, after complete healing had been documented radiographically (3 months postinjury), was evaluated through measurements of blood urea nitrogen, serum creatinine, blood pressure, and split percentage of renal function using technetium-99m-dimercaptosuccinic acid nuclear scanning. Repeated data at 1 year postinjury were compared with the early follow-up results. Results: Sixteen consecutive children (mean age, 10 years; range, 3-16 years) had complete follow-up over the study period. All children were managed without laparotomy. Injury grades were as follows: grades I to III, 4; grade IV, 9; and grade V, 3. No child had an abnormal blood urea nitrogen, serum creatinine, or blood pressure measurement at follow-up. Consistent with previous results, percentage of renal function by technetium-99m-dimercaptosuccinic acid scanning was influenced by injury grade at the early 3-month follow-up (46.5% ± 4.5%, 42% ± 7.1%, and 32.7% ± 5.9% [mean ± SD] for grades I-III, grade IV, and grade V, respectively). One-year functional results for the high-grade injuries also correlated to initial injury grade and were not significantly different from the results at early follow-up (43.8% ± 4.8%, 41.9% ± 6.6%, and 31.35 ± 5.7% [mean ± SD] for grades I-III, grade IV, and grade V, respectively; P = not significant). No child required delayed surgery. Conclusions: Long-term (1 year) functional outcome in nonoperatively managed renal injuries in children appears preserved and is influenced by injury grade.