Detection And Complications Of Renal Injuries
One renal repair surgery was performed in a patient with a left transected kidney with J-Vac drain insertion to drain left pri-renal hematoma and urinary extravasation. The other renal procedure was a cystoscopy with double J stent insertion and retrograde pyelogram. This was done in three patients. The first was for sever renovascular injuries which consisted of multiple avulsions to the right kidney, sever retroperitoneal hematoma and urinary extravasations. The second was for blood clots that blocked the pelvicalyceal system and resulted in hydronephrosis. The third was for pelvicalyceal system injury resulting in severe urinary extravasation. All three patients were followed up after three months for cystoscopy and double J stent removal.
All the cases reviewed in this report underwent renal CT for grading of renal injuries. It is the gold standard for diagnosing renal injury as it allows for the accurate evaluation of the renal vasculature, parenchyma, and collecting system. We looked at US radiology reports to evaluate whether or not they can be used as rapid detection approach for renal trauma. Nine patients (64. 2%) underwent US imaging initially as part of trauma evaluation. Renal injuries were detected in eight patients (88%). These results are supported by the literature, as a recent study illustrated that 91% (77out of 84) of renal injuries were correctly diagnosed by US imaging and the undetected seven cases were grade 1 injury. These results demonstrate that US imaging is an excellent method for rapidly detecting renal injuries specifically high-grade renal injuries which makes the US imaging the first choice of imaging in trauma cases.
Renal function was encouraging as the renal function was preserved in 13 (92. 8%) of injuries which were consistent with other studies that demonstrated a 99% renal salvage rate. All cases had a good renal function upon discharge this was determined through serum creatinine levels. After all, a long-term renal function was difficult to assess as follow up blood tests and radiology was needed and not usually conducted. Provided that renal workup was done if patients displayed any signs or symptoms of renal disease the medical records showed that there were none displayed by any patient. Identifying long-term renal trauma complications needed a lengthy follow-up period. One of the known rare drawbacks for renal trauma is hypertension. We were able to record 1 year follow up BP in nine children (64. 2%) in our sample population. This was because BP measurement is a routine part of hospital checkup and, only two demonstrated mildly high blood pressure. Therefore, we can’t report the presence of hypertension as we defined it in our sample. Other long-term complications in our sample were 3 children presented with persistent hematuria caused by low-grade and high-grade injuries. Other complications were evident on patients who underwent follow up imaging included: two children who developed renal scars, one had hydronephrosis and one had renal cyst formation.
After all, the literature lacks long-term follow up data to determine long-term complication correlated with pediatric renal injuries also, research needs to be done on long-term renal outcomes and complications between conservative vs. operative management. Since this is a retrospective study which carries its own limitation with the design this opens the opportunity for future prospective studies. Data was acquired from patient’s medical records that were managed by a wide range of hospital staff over an extended period.
Moreover, this study was conducted in a referral center and not a major trauma center so, the numbers of cases were limited, and cases were usually more severe than the general demographic. Additionally, renal follow-up radiology and blood tests are not regularly done thus follow up renal function cannot be determined. Finally, long-term complications need additional follow up research.
