Renal trauma in children.

In children the kidney is the organ most frequently injured as a result of blunt abdominal trauma. Controversy exists as to the management of injuries of intermediate severity. At the Hôpital Sainte Justine in Montreal, from 1970 to 1976, 71 children aged 2 to 15 years were admitted because of renal trauma caused by blunt abdominal injury. Class I or II lesions (minor injuries) were found in 69% and class III or IV lesions (major or critical injuries) in 31%. Several severe injuries were treated conservatively. There was one death due to multiple associated injuries. Ten patients underwent surgery; nephrectomy was performed in one and heminephrectomy in two patients. One patient with an avulsion injury to the pedicle survived after "bench surgery" and reimplantation of the bruised kidney. Follow-up was obtained in 57 patients; 2 showed posttraumatic scarring. None required subsequent nephrectomy for hypertension or infection.