Evaluation of the Management of Severe Trauma Kidney Injury and Long Term Renal Function in Children

Abstract

Objective: To evaluate the management and long term renal function with DMSA scintigraphy in pediatric severe traumatic kidney injury (STKI) grade IV (STKI IV) and V (STKI V) at the trauma center of Grenoble teaching hospital. Materials and methods: This is a single-center retrospective study between 2004 and 2014. All children under the age of 15 managed at the Grenoble teaching hospital for a STKI IV or V were included. The trauma grade was radiologically diagnosed on arrival at hospital, using the classification of the American association for surgery of trauma. The management followed the algorithm in effect in the establishment. The assessment of the renal function was performed by a DMSA scintigraphy after at least 6 months from the injury. Results: 21 children were managed at the Grenoble teaching hospital for a severe traumatic kidney injury (16 STKI IV and 5 STKI V). The diagnosis was initially made by an ultrasonography (8 cases) or a CT-scan (13 cases). A child with STKI IV underwent a nephrectomy on day 6 of the trauma. Eleven children needed a therapeutic procedure (3 embolizations, 4 double J stents, 1 arterial stent, 1 peritoneal lavage for a splenic hemoperitoneum, 4 pleural drainages). A DMSA scintigraphy was performed in 15 patients to assess the function of the injured kidney: 11/16 STKI IV with an average of 39.4%, and 17% for the 4/5 STKI V analyzed. Conclusion: Among the 21 children managed for a STKI IV (16 cases) or STKI V (5 cases), 11 required a therapeutic procedure, one of them a nephrectomy. The DMSA scintigraphy performed after at least 6 months from the trauma, found an injured renal function at 39.4% for the 11/16 SKI IV analyzed, and 17% for the 4/5 SKI V analyzed. There is therefore a significant long term recovery of the renal function in children with STKI (especially STKI IV), confirming the currently conservative management.