Management of children with kidney injuries of various severity: a series of clinical observations

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Abstract

BACKGROUND: Kidney injury takes approximately 1–5% of all urinary tract and abdominal cavity injuries. Children blunt trauma amounts more than 90% of all kidney damages. Kidney injury is always followed by pain in the lumbar region and abdomen as well as by hematoma and hematuria. Serious renal injuries in children are more often accompanied by stable vital functions and normal general urine analyses compared to adults. Such patients require dynamic observation and instrumental examination so as to determine further curative strategy.

CLINICAL CASE DESCRIPTION: This article describes three clinical cases of kidney injury in children. In the first case, ultrasound examination and computed tomography revealed contusion changes in the kidney, subcapsular hematoma and renal parenchyma rupture without damage of the collecting system. Due to clinical findings, ultrasound and computed tomography examination, conservative management was prescribed to one patient, while for the other two with renal parenchyma rupture — surgery. One of these patients had malformation — a gap between the upper and lower segments of the double kidney. Such malformation could aggravate the injury.

CONCLUSION: The present series of clinical observations is an example of managing children with kidney injuries of varying severity. Depending on the damage severity, conservative management or surgical tactics are chosen by specialists.

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About the authors

Semyon L. Kovarsky

Russian National Research Medical University named after N.I. Pirogov; N.F. Filatov Children's City Hospital

Email: semen2150@mail.ru
ORCID iD: 0000-0001-6310-7110
SPIN-code: 9308-5014

MD, Dr. Sci. (Medicine), Professor

Россия, Moscow; Moscow

Andrey I. Zakharov

N.F. Filatov Children's City Hospital

Email: zaharov@pedurology.ru
ORCID iD: 0000-0002-8415-4968
SPIN-code: 8774-5827

MD, Cand. Sci. (Medicine)

Россия, Moscow

Zuleikha Z. Sottaeva

Russian National Research Medical University named after N.I. Pirogov; N.F. Filatov Children's City Hospital

Email: sottaeva@pedurology.ru
ORCID iD: 0000-0003-2522-904X
SPIN-code: 5275-0034

MD, Cand. Sci. (Medicine)

Россия, Moscow; Moscow

Kirill A. Struyansky

N.F. Filatov Children's City Hospital

Email: kirill-str89@mail.ru
ORCID iD: 0000-0002-1947-1035

MD, Cand. Sci. (Medicine)

Россия, Moscow

Leyla M. Shvedova

Russian National Research Medical University named after N.I. Pirogov

Author for correspondence.
Email: leyla2903@yandex.ru
ORCID iD: 0000-0001-9626-7663
Россия, Moscow

Vladimir A. Shvedov

Russian National Research Medical University named after N.I. Pirogov

Email: shvedovvvladimir@yandex.ru
ORCID iD: 0000-0001-8207-7922
Россия, Moscow

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  7. Sabounji SM, Gueye D, Ngom G. Blunt abdominal trauma in children: A review of 105 cases. J Indian Assoc Pediatr Surg. 2023;28(1):48–53. doi: 10.4103/jiaps.jiaps_171_21
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  10. Duarsa GW, Satyagraha P. Non-operative management for high-grade isolated renal trauma in pediatric patients: A case series. Pan African Med J. 2023;(44):71. EDN: PGOAMB doi: 10.11604/pamj.2023.44.71.36833

Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. Ultrasound examination of kidneys: incomplete duplication of the left kidney, violation of capsule integrity, perinephric hematoma

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3. Fig. 2. Ultrasound of kidneys with color Doppler mapping: avascular rupture zone

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4. Fig. 3. Computed tomogram of parenchyma transverse rupture in the doubled left kidney at the border of upper and lower halves with the formation of a large perirenal hematoma and urine leakage into the perirenal space

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5. Fig. 4. 3D model of the left double kidney: computed tomogram of parenchyma transverse rupture at the border of upper and lower halves

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6. Fig. 5. Intra-operative picture

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7. Fig. 6. Ultrasound of the kidneys in 6 months after injury: scar is seen at the border of the upper and lower halves (arrow)

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8. Fig. 7. Ultrasound examination of kidneys in 6 months after the injury: color Doppler mapping reveals no changes in the blood flow

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9. Fig. 8. Static nephroscintigraphy

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10. Fig. 9. Ultrasound of kidneys: a — a linear defect of the renal parenchyma (arrow) and a paranephric hematoma; b — color Doppler mapping reveals no blood flow in kidney lower segments

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11. Fig. 10. Computed tomogram of the abdominal cavity: an incomplete transverse rupture of the kidney with the formation of a paranephric hematoma is seen at the border of middle (a) and lower (b) segments of the right kidney (circle)

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12. Fig. 11. Contrast agent leak in the kidney posteromedial edge (circle)

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13. Fig. 12. 3D model of the right kidney: computed tomogram shows an incomplete transverse rupture of the right kidney (arrow)

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14. Fig. 13. Intra-operative picture

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15. Fig. 14. Ultrasound examination of the kidneys in 6 months after the injury: a — the zone of "retraction" and scarring (arrow); b — in the color Doppler mapping mode, the avascular subcapsular zone is seen (arrow)

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16. Fig. 15. Static nephroscintigraphy

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Copyright (c) 2024 Kovarsky S.L., Zakharov A.I., Sottaeva Z.Z., Struyansky K.A., Shvedova L.M., Shvedov V.A.

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