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Optimal renal preservation with timely percutaneous intervention: a changing concept in the management of blunt renal trauma in children in the 1990s.

OBJECTIVE
To report the results of treatment of 132 children with blunt renal trauma and indicate our treatment recommendations.


RESULTS
Between 1971 and 1991 132 children presented with blunt renal trauma. Grade I injuries (renal contusion) were seen in 97 children, grade II injuries (renal laceration) in 32 and grade III (shattered kidney and pedicle injury) in three. Twenty-six children with grade II injuries were treated non-surgically. Urinomas developed in three, which were drained percutaneously with complete resolution. Prior to 1985 six patients with grade II injuries underwent total or partial nephrectomy for major renal lacerations. Repair of shattered kidneys resulted in significant morbidity. Conservative management of major blunt injuries with judicious percutaneous intervention resulted in no renal loss.


CONCLUSION
We believe that conservative therapy with timely percutaneous drainage of urinomas in children with major blunt renal injury, other than shattered kidney or pedicle injuries, optimizes renal preservation and minimizes secondary complications.