Téma: 

Children kidney trauma

Ivo Novák, Richard Fiala, Petr Morávek jr., Leona Janoušková, Baker Khalid, Petr Kutílek, Jaroslav Koudelka, Miroslava Králová, Peter Kuliaček, Martin Toušek, Libor Janeček, Pavel Rejtar, Jan Kopřiva, Jana Dědková, Antonín Krajina, Jan Raupach, Pavel Eliáš, Milan Bayer, Antonín Lukeš, Tomáš Chyba, Skálová Sylva, Elen Urbanová, Vižďa Jaroslav

Introduction: Diagnostic methods, treatment options and clinical outcomes were evaluated retrospectively in children with kidney trauma. Material and Methods: 31 children of average age 9 (from 3 to 14 years) with kidney trauma were treated from 5/2000 to 12/2007 in the University Hospital Hradec Králové. Left kidney trauma was found in 14 children (45 %), right kidney trauma in 13 children (42 %, solitary kidney in 3 cases) and bilateral trauma in 4 children (13 %) in our study population. Concomitant parenchyma organ injury was found in 7 children (23 %). The main trauma causes were: blunt kidney trauma in 20 (65 %) cases, fall from a height in 5 (16 %) cases, car accident in 5 (16 %) cases and blunt abdominal trauma in 1 (3 %) case. Posttraumatic macro haematuria (in 68 %) and abdominal pain (in 94 %) were the main symptoms. Ultrasound examination was made in 29 (94 %) children; contrast medium CT examination was superadded in 20 (65 %) patients. An intravenous urogram (IVU), a magnetic resonance imaging (MRI), an abdomen angiogram and an antegrade pyelogram were also used. Conservative treatment strategy (bed rest, haemostyptic drugs) was chosen in 29 (94 %) children. Surgical revision was indicated in only two cases – in a case of kidney abruption (with an urinoma and haematoma formation and development of malignant posttraumatic arterial hypertension) and in a case of traumatic avulsion of the kidney vascular supply. Results: 18 (58 %) kidney trauma grade I, 6 (19.5 %) kidney trauma grade II, III, 6 (19.5 %) kidney trauma grade IV and 1 (3 %) kidney trauma grade V were diagnosed by ultrasound and CT imaging. Good correlation (87 %) was found for trauma grade assessment by ultrasound and CT examination in our study. Mild trauma (grade I) were healed ad integrum. Parenchyma scares (diagnosed by ultrasound and radioisotope methods) without changes in kidney functions were found in patients with injuries grade II-IV. Secondary arterial hypertension developed in only one treated patient. Conclusion: Ultrasound and contrast medium CT are considered to be the gold standard for kidney trauma diagnosis determination. Conservative treatment strategy is preferred, the organs saving operations are chosen in cases of emergency. Such treatment strategy has very good results.

Ročník 2008  Témy časopisu Clinical urology 2 / 2008

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