Review of the evidence on the management of blunt renal trauma in pediatric patients

@article{Fraser2008ReviewOT,
  title={Review of the evidence on the management of blunt renal trauma in pediatric patients},
  author={Jason D. Fraser and Pablo Aguayo and Daniel J. Ostlie and Shawn D. St. Peter},
  journal={Pediatric Surgery International},
  year={2008},
  volume={25},
  pages={125-132}
}
Due to the size and location within the pediatric patient, the kidneys are susceptible to injury from blunt trauma. While it is clear that the goal of management of blunt renal trauma in children is renal preservation, the methods of achieving this goal have not been well established in the current literature. Therefore, we have set out to summarize and clarify the current published information on the management strategies for blunt renal trauma in children. While there is extensive literature… 
Blunt Renal Trauma.
TLDR
This review is written to summarize the different approaches to blunt renal trauma and highlight opportunities for further research.
Characteristics and Management of Blunt Renal Injury in Children
TLDR
Blunt renal trauma is uncommon in children and is typically of low American Association for the Surgery of Trauma injury grade, commonly associated with other intra-abdominal injuries, especially the liver and the spleen.
Nonoperative management of blunt renal injury: a need for further study.
Pediatric blunt abdominal trauma in the emergency department: evidence-based management techniques.
TLDR
The history and physical examination, combined with the mechanism of injury, should be used to develop a thoughtful and directed diagnostic workup and the routine use of laboratory, sonography, and computed tomography studies may not be necessary.
Nonoperative Management of Blunt Renal Trauma
TLDR
Blunt renal trauma can be successfully managed conservatively, with low complication rates, and nonoperative management is safe in stable patients and in environments with appropriated protocol for this approach.
Renal trauma after blunt abdominal injury.
Closed kidney injury.
The role of interventional radiology for pediatric blunt renal trauma
TLDR
TAE is an alternative therapeutic modality for blunt renal injury in children who have contrast medium extravasations in the kidney on angiography and all patients had normal renal function at follow-up.
Nonoperative Management of Blunt Solid Organ Injury in Pediatric Surgery.
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References

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Blunt renal injuries in Turkish children: a review of 205 cases
TLDR
A retrospective analysis of the medical records of 205 children with renal injuries secondary to blunt abdominal trauma found that the absence of hematuria on initial urinalysis does not exclude a serious renal injury, and all children should undergo imaging procedures to exclude renal injury.
Blunt renal trauma in the pediatric patient.
Blunt renal injuries in children can be managed nonoperatively: outcome in a consecutive series of patients.
TLDR
A nonoperative management strategy was advantageous and successful in pediatric blunt renal injuries (94.7% successful nonoperative rate, 98.9% renal salvage rate) and adjunctive urologic procedures were beneficial in selected cases.
Major blunt renal trauma in the pediatric population: is a nonoperative approach indicated?
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TLDR
Ulasonography and urinalysis were found to be the optimal diagnostic methods for screening and following the course of renal injury and CT scan proved to be most reliable for detecting and exactly classifying renal lesions grade 2 or higher and superseded consecutively iv-urography.
Pediatric renal injuries: management guidelines from a 25-year experience.
TLDR
Pediatric renal trauma is often minor and observation poses no significant danger to the child, and the standard of care is renal preservation (less than 1% nephrectomy rate in this series).
The literature increasingly supports expectant (conservative) management of renal trauma--a systematic review.
TLDR
Most modern citations support at least a trial of expectant management for renal trauma patients not exsanguinating from the kidney, and without ureteral or renal pelvis injuries.
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