Major blunt renal trauma in the pediatric population: is a nonoperative approach indicated?

We evaluated and treated at our institutions 22 consecutive patients with major blunt renal trauma: 20 had major renal lacerations (grades 3 to 5) as defined by initial computerized tomography, and 2 had vascular pedicle injuries without parenchymal injury and were excluded. An attempt was made to treat all children with a nonoperative approach. Two patients (10%) required renal exploration: 1 for persistent bleeding and 1 in whom a renal neoplasm could not be excluded. The remaining 18 patients (90%) were stabilized and observed. No child required delayed renal exploration. All traumatized renal units demonstrated function on followup studies. Hypertension did not occur in the 13 patients available for long-term followup. We conclude that nonoperative management is a suitable alternative to early exploration in children with major blunt renal lacerations.