Functional outcome of nonoperatively managed renal injuries in children

Background: This study aimed to define better the functional outcome of nonoperatively managed renal injuries in children. Methods: All children who had blunt renal trauma managed nonoperatively were reviewed for injury grade, blood urea nitrogen (BUN), creatinine, blood pressure, and percentage-of function according to technetium-99m-dimercaptosuccinic acid renal scan after complete healing. Results: Over a 2-year period, 17 children (mean age, 10.4 years) were managed conservatively for their renal injuries. There were two grade 2, two grade 3, nine grade 4, and four grade 5 injuries. Complete healing was documented in all cases within 3 months after injury. Renal scarring and volume loss were evident for all healed high-grade injuries (grades 4 to 5) at follow-up imaging. Technetium-99m-dimercaptosuccinic acid scanning demonstrated a decline in percentage of total renal function corresponding to injury severity (44.7 ± 8.4% function for grades 2 and 3, 41.8 ± 9.2% for grade 4 vs 29.5 ± 7.9% for grade 5). Only two children (22%), however, with grade 4 injury had severe compromise of function (<30%). At the follow-up visit, all the children were asymptomatic and normotensive. None had abnormal BUN or creatinine (mean BUN, 10.5 ± 5.1 mg/dL; mean creatinine, 0.6 ± 0.2 mg/dL). Conclusions: The functional outcome for children with nonoperatively managed kidney injuries is good and correlates with injury grade. Children with grades 2 to 4 injuries managed conservatively retain near normal function. Those with grade 5 injuries have a loss of function attributable to scarring and parenchymal volume loss. Long-term follow-up evaluation of these children may be warranted.