Renal trauma in a pediatric Level 1 trauma center: morbidity, mortality, and the role of renal scintigraphy.

Abstract

Purpose: Pediatric renal trauma is uncommon but potentially serious, and is often managed conservatively. Complications may occur, and the clinical value of renal scintigraphy during follow-up remains unclear. This study aimed to assess morbidity and mortality after pediatric renal trauma and to assess the clinical value of renal scintigraphy during follow-up.

Methods: This retrospective single-center cohort study included pediatric trauma patients (< 18 years) with renal injuries admitted to a Level 1 trauma center in the Netherlands between January 1, 2001, and December 31, 2024. Mortality and in-hospital complications were assessed, and associations between renal scintigraphy abnormalities and complications during follow-up were evaluated.

Results: A total of 72 patients were included, of whom all injuries resulted from blunt trauma. Conservative management was applied in 88% of cases; embolization and nephrectomy were performed in 8% and 3% of patients, respectively. In-hospital mortality was 11% and was attributed exclusively to concomitant traumatic brain injury. Complications occurred in 25% of patients, primarily infections (19%), followed by hypertension during follow up (4%). Renal scintigraphy was performed in 53% of patients, predominantly in those with high-grade injuries; abnormalities were frequently observed (77%) but did not correlate with the occurrence of hypertension, proteinuria, or renal insufficiency during follow-up.

Conclusion: Pediatric renal trauma, including high-grade injuries, can often be managed conservatively, and most complications can be treated using medical therapy or minimally invasive interventions. Renal scintigraphy showed no clear association with long-term morbidity and had limited additional value in routine follow-up. Given the potential for late-onset hypertension, structured long-term clinical surveillance with periodic monitoring of blood pressure, proteinuria, and renal function is warranted, particularly after high-grade injuries.