Prospective observational study with an abbreviated protocol in the management of blunt renal injury in children

Background: There are no published management schemes for blunt renal injuries. We are conducting a 2-center prospective observational study with a fixed management scheme. Methods: Children with CT proven renal injuries were enrolled with permission. Ambulation is allowed when able regardless of grade. Discharge occurs when tolerating a diet and pain is controlled regardless of hematuria. Urinalysis occurs at follow up in 2-4 weeks and repeated as indicated. Results: Between 9/2008 and 9/2012, 70 patients were enrolled. Mean age was 11.8 years (3-17), and 70% were male. The mean grade of injury was 2.8 +/- 1.1 [1-5]. One nephrectomy (1.4%) was performed for a grade 5 injury. Other renal interventions included an embolization for the hilar bleed and one cystotomy for a clot. Mean LOS was 2.9 days +/- 2.4 days. In patients without other major injury, LOS was 1.9 +/- 1.7 days (0.4-8 days). There were 5 (7%) readmissions: 3 for pain, 1 for hematuria, and 1 for a bladder clot. 58 patients (83%) gave urinalysis samples at initial follow up (med 18 days), where 31 (53%) were positive for blood. Conclusions: Children with blunt renal injury may benefit from management without strict bedrest guidelines. Hematuria appears to have little influence on recovery. (C) 2014 Elsevier Inc. All rights reserved.