Selective Management of Isolated and Nonisolated Grade IV Renal Injuries

Instituting a Conservative Management Protocol for Pediatric Blunt Renal Trauma: Evaluation of a Prospectively Maintained Patient Registry

Renal Trauma from Recreational Accidents Manifests Different Injury Patterns than Urban Renal Trauma

Analysis of Diagnostic Angiography and Angioembolization in the Acute Management of Renal Trauma Using a National Data Set

Timing and Predictors for Urinary Drainage in Children with Expectantly Managed Grade IV Renal Trauma

Minimally Invasive Endovascular Techniques to Treat Acute Renal Hemorrhage

Computerized Tomography Findings in Pediatric Renal Trauma—Indications for Early Intervention?

Renal injuries account for 5% of all traumatic injuries, with blunt trauma being the most common cause (82-95%) [Meng, M.V., S.B. Brandes, and J.W. McAninch,, Renal trauma: indications and techniques for surgical exploration (17) 1999, Wessells, H., et al., Renal injury and operative management in the United States: results of a population-based study, 54(3) 2003]. Motor vehicle collisions (MVCs), pedestrian-vehicle accidents (PVAs), and falls often cause blunt renal injuries, frequently associated with intra-abdominal or thoracic trauma [Santucci, R., et al., Evaluation and management of renal injuries: consensus statement of the renal trauma subcommittee, 93(7) 2004]. Penetrating injuries, more common in urban areas, are typically severe and linked to firearm or sharp object incidents [Najibi, S., M. Tannast, and J.M. Latini, Civilian gunshot wounds to the genitourinary tract: incidence, anatomic distribution, associated injuries, and outcomes, 76(4) 2010]. Conservative management is generally recommended for grades 1-4 injuries [DiGiacomo, J.C., et al., The role of nephrectomy in the acutely injured 2001 136(9), Sujenthiran, A., et al., Is nonoperative management the best first-line option for high-grade renal trauma? A systematic review 2019 5(2)], and there is an increasing trend toward nonoperative management even for grade 5 injuries, though this remains a topic of debate [Keihani, S., et al., Contemporary management of high-grade renal trauma: results from the American Association for the Surgery of Trauma Genitourinary Trauma study 2018. 84(3), Moudouni, S., et al., Management of major blunt renal lacerations: is a nonoperative approach indicated? 2001 40(4)]. Our study aims to evaluate the impact of different treatment strategies on renal function outcomes in renal trauma patients. This multicenter, retrospective study reviewed data from 65 renal trauma patients, including clinical notes, radiology, and pathology reports. We analyzed demographics, trauma mechanisms, injury grades, associated injuries, transfusion needs, and long-term renal function assessed via DMSA scintigraphy. Angioembolization's impact on clinical stability, transfusion needs, and renal function preservation was specifically evaluated. Blunt trauma was the predominant mechanism (67.7% of cases). Angioembolization was performed in 10 patients, significantly reducing transfusion needs and preserving renal function (40% vs. 25% without; p = 0.009). Grade 5 injuries showed significant renal function decline, and conservative management increased the risk of severe complications. Urinoma developed in five cases, predominantly in high-grade injuries. Angioembolization improves outcomes in severe renal trauma by stabilizing clinical conditions, reducing blood transfusion needs, and preserving renal function better than conservative approaches. Although surgical intervention remains a necessary option in select grade 5 cases, increasing evidence supports the role of nonoperative management in appropriately selected patients. Further research is needed to refine guidelines and incorporate more cases into decision-making protocols.

Bloody Urine after Minor Trauma in a Child: Isolated Renal Injury versus Congenital Anomaly?

Dirt Bikes and All Terrain Vehicles: The Real Threat to Pediatric Kidneys

Penetrating Injuries of the Kidney: An Analysis of 181 Patients

A Conservative Approach to Testicular Rupture in Adolescent Boys

Single Center Experience With Application of the ALARA Concept to Serial Imaging Studies After Blunt Renal Trauma in Children—Is Ultrasound Enough?

Individualizing the Approach to Urological Trauma

43 A SUCCESSFUL PROSPECTIVE TRAIL OF CONSERVATIVE MANAGEMENT FOR PEDIATRIC BLUNT RENAL TRAUMA

Objective: Grades I to III are the most common kidney injuries, and they are successfully treated non-operatively with high functional preservation. The objective of this study was to review all grade IV renal injuries and report outcomes. It also sought to ascertain whether operative and selective non-operative management could result in high salvage rates and whether management and outcomes varied noticeably between cases of isolated grade IV renal injuries and those with concomitant multi-organ injuries. Method: The data of 50 grade IV kidney injuries that occurred at Department of Urology, Rajendra Institute of Medical Science, Ranchi for ten years. These were split into two groups: those with isolated grade IV renal injuries (30) and those with accompanying nonrenal injuries (20), and both groups were analyzed with regard to the kind of renal injury, operative vs. nonoperative care, operational nephrectomy rate, and operational renal salvage rate. Salvage was defined as having a 50% or greater function of the injured kidney and an overall renal function of at least 20%. Results: With an overall salvage rate of 83%, 35 of the 50 patients were operated on and 15 were not. 35 injuries were caused by penetrating trauma, 10 by blunt trauma, and 5 out of 50 (51%) were renal vascular injuries. Grade IV renal injuries requiring operational exploration that also had concurrent related injuries were healed at exploration with a 14% nephrectomy rate and an 82% salvage rate. With an average transfusion need of 8.5 units packed red blood cells, 15 (41%) of the 30 patients with isolated injuries required surgical exploration. One patient (10%) required a nephrectomy, two kidneys were postoperatively nonfunctional, and one mild complication was found. Only 10 patients needed transfusions (average 2.5 units), and 87% of the remaining 20 isolated grade IV renal injuries were handled nonoperatively. There was no need for delayed nephrectomy in any of the 35 nonoperative patients of solitary or nonisolated renal injury. Three individuals had minimal problems, while five cases had non-functioning kidneys. Conclusion: Since isolated grade IV renal injuries provide a special case where the patient must be treated purely based on the severity of the renal injury, nonoperative therapy is applied more frequently. The primary reason for exploring and reconstructing the kidneys is persistent bleeding. Non-operative therapy should only be used in all cases of severe renal damage when patients are hemodynamically stable and have undergone full renal staging.