Abstract
Blunt renal trauma accounts for the majority of renal injuries in the pediatric population, and organ-preserving management has become the preferred approach in hemodynamically stable patients. However, clinical data focusing specifically on isolated blunt renal trauma in children remain limited. In this retrospective cohort study, 28 pediatric patients (<18 years) diagnosed with isolated blunt renal trauma between January 2021 and June 2024 were evaluated. Demographic characteristics, injury mechanisms, trauma grade, treatment approaches, transfusion requirements, and hospitalization duration were analyzed. Renal injuries were classified according to the American Association for the Surgery of Trauma system. Patients were followed at 1, 3, and 12 months after discharge to assess clinical and functional outcomes. The mean patient age was 9.42 ± 3.31 years, and 60.7% were male. Low-grade renal injuries (American Association for the Surgery of Trauma I–III) were observed in 71.4% of patients. Conservative management was applied in 75% of cases, while minimally invasive interventions, including Double J Stent placement and selective angioembolization, were performed in selected patients. Surgical exploration and nephrectomy were required in 7.1% of patients. No mortality occurred. Hemoglobin and creatinine levels remained stable during follow-up, and no patient developed persistent hypertension. High-grade injuries were associated with significantly higher transfusion requirements and intervention rates. In this retrospective single-center cohort of pediatric patients with isolated blunt renal trauma, conservative management was associated with favorable clinical and functional outcomes. A patient-centered approach guided by hemodynamic stability with selective use of minimally invasive interventions when clinically indicated may help preserve renal function while reducing the need for surgical treatment. However, these findings should be interpreted in light of the retrospective study design and the relatively small sample size.
Keywords: blunt renal injury, pediatric trauma
1. Introduction
More than 90% of renal injuries in the pediatric population result from blunt trauma.[1] It has been reported that renal injury occurs in approximately 10% of pediatric abdominal blunt trauma cases, and the kidney is the most frequently affected organ in blunt abdominal trauma.[2,3] Approximately 25% of all renal injuries occur in children.[4] Due to certain anatomical characteristics of the pediatric kidney, the risk of renal injury following blunt trauma is higher in children compared to adults.[5] In addition to trauma history, physical examination findings, and laboratory investigations, imaging modalities particularly contrast-enhanced computed tomography (CT) play a fundamental role in diagnosis.[6]
Pediatric renal trauma generally presents with mild severity, and a conservative approach is often sufficient and safe.[7] With advancements in imaging techniques and increasing clinical experience, conservative management has become increasingly preferred in trauma care.[8] Regardless of the treatment modality, the primary goal in pediatric renal trauma is to preserve renal parenchyma and function while minimizing patient morbidity.[9] Conservative management is considered the gold standard in hemodynamically stable patients with minor lacerations, contusions, or subcapsular hematomas, whereas surgical treatment or invasive interventions may be unavoidable in hemodynamically unstable patients.[10]
In this context, presenting clinical data on the management of isolated blunt renal trauma in the pediatric age group is important, particularly for accurately determining the effectiveness of conservative treatment and the necessity of surgical intervention. Although numerous studies have addressed the management of renal trauma in adults, data regarding the pediatric population remain limited. Therefore, sharing clinical experience and outcomes in children provides valuable guidance for clinical practice.
A substantial proportion of the existing literature on pediatric blunt renal trauma includes patients with multisystem injuries (polytrauma). Consequently, the reported outcomes often do not allow renal injury-specific clinical outcomes to be evaluated independently of the effects of associated injuries. Studies focusing exclusively on pediatric patients with isolated blunt renal trauma are limited. Accordingly, restricting the study population to pediatric patients with isolated blunt renal trauma reduces clinical heterogeneity and enables a more homogeneous assessment of renal injury-specific clinical and functional outcomes. The aim of the present study was to evaluate the clinical and functional outcomes of conservative and minimally invasive management in pediatric patients with isolated blunt renal trauma.
2. Materials and methods
The study was initiated following approval from the Clinical Research Ethics Committee of Atatürk University Faculty of Medicine (Approval No: B.30.2.ATA.0.01.00/497; approval date: June 27, 2025). Written informed consent was obtained from the parents or legal guardians of all participants. Between January 2021 and June 2024, 28 pediatric patients under 18 years of age who were diagnosed with isolated blunt renal injury after trauma and followed at the Department of Urology, Atatürk University Faculty of Medicine, were retrospectively evaluated. Patients with multiple trauma or concomitant injuries to other organs were excluded. There were no cases of isolated penetrating pediatric renal trauma in the study group, as such patients did not present to our clinic. Since patients with multiple or associated organ injuries are generally managed by the Department of Pediatric Surgery at our institution, the study cohort consisted exclusively of pediatric patients with isolated blunt renal injuries followed in our clinic.
Demographic characteristics, mechanism of injury, presence of hematuria, grade of renal trauma, treatment modality, need for blood transfusion, length of hospital stay, and clinical outcomes were evaluated. Data was accessed for research purposes on July 1, 2025. Data were obtained from patient files, clinical visit notes, and the hospital information system, and were analyzed retrospectively. The authors had access to identifiable participant information during data collection; however, all data were anonymized prior to analysis.
Our clinic, with approximately 60 years of experience, is one of the largest tertiary care centers in Türkiye and provides services to several neighboring provinces. In the diagnostic evaluation and management of renal trauma, the European Association of Urology Guidelines on Urological Trauma and Pediatric Urology were adopted. In this context, contrast-enhanced CT is used as the gold standard method in the initial evaluation of renal trauma in our clinic. During the acute and early post-trauma period, repeat imaging in clinically stable patients with low-grade injuries was performed selectively according to clinical indications.
Renal injuries were graded according to the American Association for the Surgery of Trauma (AAST) classification system. Grade I–III renal injuries were considered low-grade, whereas Grade IV and V injuries were classified as high-grade.
In accordance with the literature, the primary determinant of treatment approach was hemodynamic stability. Hemodynamic instability was defined according to the World Society of Emergency Surgery guidelines as persistent circulatory compromise requiring immediate intervention despite appropriate fluid resuscitation. Although age-adjusted hypotension was considered an important criterion, the overall clinical assessment, including the patient’s response to fluid resuscitation, heart rate, mental status, peripheral perfusion, and urine output, was prioritized when determining hemodynamic instability.[11]
Hemodynamically stable patients were initially managed conservatively, including bed rest, close monitoring of vital signs, regular measurement of hematocrit levels, analgesia, and antibiotic therapy. Empirical antibiotic therapy was initiated in selected patients based on clinical assessment, considering the potential risk of infectious complications and the possibility of requiring an invasive intervention during follow-up. The decision to initiate antibiotic therapy was individualized according to the patient’s clinical condition and anticipated need for intervention. In patients who remained hemodynamically stable but demonstrated persistent bleeding despite initial conservative management, selective angioembolization was considered. Surgical exploration was reserved for patients with persistent hemodynamic instability or clinical deterioration requiring operative management.
In patients with high-grade renal injuries, follow-up CT was performed on days 2 to 4 after trauma to avoid missing potential complications. In contrast, during the acute and early post-trauma period, no repeat cross-sectional imaging was routinely performed in clinically stable patients with Grade I–III injuries unless clinically indicated.
All patients were scheduled for outpatient follow-up at 1, 3, and 12 months after discharge. During follow-up, patients were evaluated with urinalysis, renal function tests, and blood pressure measurements. At the 3-month follow-up, as part of the institutional follow-up protocol, contrast-enhanced CT and dimercaptosuccinic acid (DMSA) scintigraphy were routinely performed in patients who had not undergone nephrectomy. Contrast-enhanced CT was used to assess intermediate-term morphological changes in the renal parenchyma and to identify residual hematoma, urinoma, or other renal trauma-related complications, while DMSA scintigraphy was used for functional assessment of the affected kidney. The combined use of these modalities was intended to provide complementary anatomical and functional evaluation during follow-up. All patients completed the planned 12-month follow-up, and no patients were lost to follow-up.
Patients were stratified into 2 groups according to injury severity: low-grade (AAST I–III) and high-grade (AAST IV–V) renal injuries. All statistical analyses were performed using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk). The normality of continuous variables was assessed using the Shapiro–Wilk test. Continuous variables were expressed as mean ± standard deviation when normally distributed and as median (interquartile range [IQR]) when the distribution deviated from normality. Given the relatively small subgroup sizes and the distributional characteristics of the data, comparisons between low-grade and high-grade injury groups were performed using the Mann–Whitney U test for continuous variables and Fisher’s exact test for categorical variables.
Comparisons included length of hospital stay, transfusion requirement, presence of gross hematuria, and need for intervention (Double J [DJ] stent placement, angioembolization, or surgery). A P value < .05 was considered statistically significant.
3. Results
The mean age of the pediatric patients included in the study was 9.4 ± 3.31 years, and 60.7% were male. All injuries were unilateral. None of the patients had a known congenital or acquired renal disease. When the mechanism of injury was analyzed, the most common cause was fall from height (53.6%), followed by traffic accidents (32.1%), bicycle accidents (10.7%), and horse kicks (3.6%). Injuries involved the right kidney in 60.7% and the left kidney in 39.3% of cases. According to renal trauma grading, 71.4% of patients had low-grade (Grade 1–3) injuries, while 28.6% had high-grade (Grade 4–5) injuries. Regarding hematuria, 42.9% of patients had gross hematuria, 32.1% had microscopic hematuria, and 25% had no hematuria. At admission, the mean hemoglobin level was 12.50 ± 1.15 g/dL, and the mean creatinine level was 0.62 ± 0.13 mg/dL. The demographic and clinical characteristics of the patients are presented in Table 1.
Table 1.
Demographic and clinical characteristics of patients with isolated blunt pediatric renal trauma.
| (n = 28) Mean ± SD/% |
|
|---|---|
| Age (Yr) | 9.42 ± 3.31 |
| Sex | |
| Male | 17 (60.7%) |
| Female | 11 (39.3%) |
| Mechanism of injury | |
| Fall from height | 15 (53.6%) |
| Traffic accident | 9 (32.1%) |
| Bicycle accident | 3 (10.7 %) |
| Animal kick | 1 (3.6 %) |
| Side of injury | |
| Right | 17 (60.7 %) |
| Left | 11 (39.3 %) |
| Injury grade (AAST) | |
| Grade 1 | 9 (32.1%) |
| Grade 2 | 7 (25%) |
| Grade 3 | 4 (14.3%) |
| Grade 4 | 5 (17.9%) |
| Grade 5 | 3 (10.7%) |
| Hematuria | |
| Macroscopic | 12 (42.9%) |
| Microscopic | 9 (32.1%) |
| None | 7 (25%) |
| Hemoglobin level at presentation (g/dL) | 12.50 ± 1.15 |
| Serum creatinine level at presentation (mg/dL) | 0.62 ± 0.13 |
AAST = American Association for the Surgery of Trauma, SD = standard deviation.
Evaluation of treatment approaches among the 28 pediatric patients showed that the majority were managed conservatively. Conservative treatment was applied in 75% (n = 21) of patients. Surgical exploration and nephrectomy were required in 7.1% (n = 2). Among minimally invasive interventions, DJ stent placement was performed in 7.1% (n = 2), and selective angioembolization in 10.7% (n = 3) of patients. No procedure-related complications were observed following angioembolization, DJ stent placement, or surgical exploration and nephrectomy. Representative CT images, surgical images, and selective angioembolization images of patients with renal trauma are shown in Figure 1.
Figure 1.
Representative imaging and treatment examples illustrating the spectrum of pediatric blunt renal trauma and the corresponding management approaches. (1) Contrast-enhanced CT showing a right renal subcapsular hematoma consistent with a Grade I injury, representative of low-grade renal trauma managed conservatively. (2) Contrast-enhanced CT showing a Grade IV right renal injury. (3) Contrast-enhanced CT showing a Grade V right renal injury. (4) Nephrectomy specimen from a patient with a Grade V renal injury requiring surgical management. (5) Renal angiographic image of a Grade IV injury before selective angioembolization. (6) Post-embolization angiographic image demonstrating the result of selective angioembolization. Together, these images illustrate the range of management strategies used in the cohort, from conservative management in low-grade injury to selective angioembolization and surgical treatment in appropriately selected high-grade injuries. CT = computed tomography.
The median length of hospital stay was 6.0 days (IQR, 5.0–9.3). Blood transfusion was required in 14.3% (n = 4) of patients, whereas 85.7% (n = 24) did not require transfusion. No mortality was observed. Treatment outcomes in pediatric patients with isolated blunt renal trauma are summarized in Table 2.
Table 2.
Results regarding treatment approaches in pediatric patients with isolated blunt renal trauma.
| (n = 28) |
|
|---|---|
| Treatment method | |
| Conservative | 21 (75%) |
| Exploration/Nephrectomy | 2 (7.1%) |
| DJ stent placement | 2 (7.1 %) |
| Selective angioembolization | 3 (10.7 %) |
| Hospitalization duration (d), median (IQR) | 6.0 (5.0–9.3) |
| Need for blood transfusion | |
| Yes | 4 (14.3 %) |
| No | 24 (85.7 %) |
DJ Stent = Double J stent, IQR = interquartile range.
During post-discharge follow-up at 1, 3, and 12 months, hematological, biochemical, and clinical parameters were evaluated. The mean hemoglobin levels were 12.95 ± 1.29 g/dL at 1 month, 13.14 ± 1.24 g/dL at 3 months, and 13.23 ± 1.09 g/dL at 12 months. Creatinine levels were 0.61 ± 0.11 mg/dL at 1 month, 0.61 ± 0.10 mg/dL at 3 months, and 0.62 ± 0.10 mg/dL at 12 months. Hemoglobin and creatinine values remained within normal limits and stable throughout follow-up. At the 1-month follow-up, urinalysis results were normal in 92.9% (n = 26) of patients; 3.6% (n = 1) had microscopic hematuria, and 3.6% (n = 1) had a urinary tract infection. At the 3- and 12-month follow-ups, urinalysis results were normal in all patients (100%).
Mean systolic blood pressure was 102.0 ± 8.41 mm Hg at 1 month, 102.4 ± 7.19 mm Hg at 3 months, and 100.1 ± 9.23 mm Hg at 12 months. Mean diastolic blood pressure was 65.71 ± 8.99 mm Hg at 1 month, whereas median diastolic blood pressure was 60.0 mm Hg (IQR, 55.0–65.0) at 3 months and 60.0 mm Hg (IQR, 57.3–66.3) at 12 months. No patient developed persistent hypertension during follow-up. During the 12-month follow-up period, no delayed trauma-related complications or unplanned readmissions were observed. No additional interventions were required, except for the planned removal of previously placed DJ stents. Clinical and laboratory follow-up findings at 1, 3, and 12 months are summarized in Table 3.
Table 3.
Clinical and laboratory follow-up findings at 1, 3, and 12 months after discharge in pediatric patients with isolated blunt renal trauma.
| 1st mo (n = 28) |
3rd mo (n = 28) |
12th mo (n = 28) |
|
|---|---|---|---|
| Hemoglobin (g/dL) | 12.95 ± 1.29 | 13.14 ± 1.24 | 13.23 ± 1.09 |
| Serum creatinine (mg/dL) | 0.61 ± 0.11 | 0.61 ± 0.10 | 0.62 ± 0.10 |
| Urine test | |||
| Normal | 26 (92.9 %) | 28 (100 %) | 28 (100 %) |
| Microscopic hematuria | 1 (3.6 %) | – | – |
| Urinary tract infection | 1 (3.6 %) | – | – |
| Systolic blood pressure (mm Hg) | 102.0 ± 8.41 | 102.4 ± 7.19 | 100.1 ± 9.23 |
| Diastolic blood pressure (mm Hg) |
65.71 ± 8.99 | 60.0 (55.0–65.0) | 60.0 (57.3–66.3) |
Continuous variables are presented as mean ± SD when normally distributed and as median (IQR) when non-normally distributed. Categorical variables are presented as n (%).
IQR = interquartile range, SD = standard deviation.
When low-grade (AAST I–III) and high-grade (AAST IV–V) renal injuries were compared, differences between the groups were observed. Although the median length of hospital stay was longer in patients with high-grade injuries (10.5 [IQR, 5.8–15.3] vs 6.0 [IQR, 5.0–8.0] days), the difference did not reach conventional statistical significance (P = .064). Nevertheless, the observed numerical difference may be clinically relevant and should be interpreted cautiously in the context of the small subgroup sizes and limited statistical power. In contrast, the requirement for blood transfusion was significantly higher in the high-grade group (50% vs 0%, P = .003). Similarly, the need for invasive intervention was markedly greater in high-grade injuries (87.5% vs 0%, P < .001). Gross hematuria was also significantly more frequent in high-grade trauma (87.5% vs 10%, P < .001). Beyond statistical significance, the magnitude of these differences was clinically notable, with high-grade injuries showing substantially higher proportions of transfusion requirement, invasive intervention, and macroscopic hematuria compared with low-grade injuries. The results of the comparison between low-grade (AAST I–III) and high-grade (AAST IV–V) renal injuries are summarized in Table 4.
Table 4.
Comparison of clinical outcomes between low-grade and high-grade renal injuries.
| Variable | Low-grade (AAST I–III, n = 20) | High-grade (AAST IV–V, n = 8) | P value |
|---|---|---|---|
| Hospital stay (d), median (IQR) | 6.0 (5.0–8.0) | 10.5 (5.8–15.3) | .064 |
| Blood transfusion, n (%) | 0 (0%) | 4 (50%) | .003 |
| Intervention required*, n (%) | 0 (0%) | 7 (87.5%) | <.001 |
| Gross hematuria, n (%) | 2 (10%) | 7 (87.5%) | <.001 |
AAST = American Association for the Surgery of Trauma, DJ = Double J, IQR = interquartile range.
Intervention includes DJ stent placement, angioembolization, or surgical exploration.
Among the 26 patients who did not undergo nephrectomy, third-month CT and scintigraphic evaluations were analyzed. On contrast-enhanced CT performed at the third month, all patients (n = 26) demonstrated normal renal parenchymal structure. DMSA scintigraphy performed during the same period revealed a mean differential renal function of the injured kidney of 49.34 ± 1.8%.
4. Discussion
Due to certain anatomical and physiological characteristics, children have a higher risk of renal injury following blunt abdominal trauma compared to adults. The relatively lower position of the kidneys within the abdomen, resulting in less protection by the ribs, increased mobility, insufficient development of perirenal fat tissue, and the proportionally larger size of the kidneys within the abdominal cavity are among the main contributing factors.[2,12] In addition, the literature reports an increased risk of post-traumatic renal injury in children with congenital renal anomalies.[13] Given this known increased risk and the fact that the kidney is one of the most frequently affected solid organs after blunt abdominal trauma, careful and systematic renal evaluation is essential in the pediatric population.
Previous studies evaluating pediatric renal trauma have reported a wide distribution in patient age and mechanisms of injury. Werner et al reported a mean patient age of 15 years,[14] whereas Stein et al reported a mean age of 5.6 years.[15] Marcou et al reported a mean age of 14 years and identified motor vehicle accidents, falls from height, and sports injuries as the most common causes of injury.[16] In general, motor vehicle accidents and falls are the leading causes of blunt abdominal trauma in children.[17] In our study, the mean age was 9.42 ± 3.31 years, which is consistent with the range reported in the literature. The most common mechanism of injury was falls from height (53.6%), followed by traffic accidents (32.1%). This distribution is consistent with studies emphasizing falls as a major cause of trauma in the pediatric population. The substantial contribution of traffic accidents also supports the role of high-energy trauma in pediatric renal injuries. However, as our center is a tertiary referral hospital serving a broad geographic region, this may have partially influenced the distribution of trauma mechanisms.
Regarding injury severity, low-grade (Grade I–III) injuries are reported to predominate in pediatric blunt renal trauma. In a series of 111 pediatric cases, Aguayo et al reported that 84% of injuries were Grade 1 to 3.[18] Although hematuria is considered the most sensitive and common clinical finding in pediatric renal trauma, its severity does not always correlate with injury grade.[19] Laboratory parameters at admission are generally within normal limits, and renal function is typically preserved in the acute phase.[5] While limited data exist regarding admission hemoglobin levels, most studies focus primarily on hemodynamic stability, reporting that the majority of patients remain hemodynamically stable.[20] In our study, 71.4% of patients had low-grade injuries and 28.6% had high-grade injuries, consistent with the literature. Hematuria was observed in most cases, although 25% had no hematuria, supporting previous reports that hematuria, although important, is not universally present. The mean admission hemoglobin and creatinine levels further suggest preserved renal function and absence of significant systemic blood loss in most patients.
Current management of pediatric blunt renal trauma favors non-operative treatment in hemodynamically stable patients, including selected patients with high-grade injuries, consistent with recommendations from the Eastern Association for the Surgery of Trauma /Pediatric Trauma Society and the American Urological Association.[21–23] Supporting this contemporary management approach, the Multi-Institutional Pediatric Acute Renal Trauma Study (Mi-PARTS), which included 1216 pediatric renal trauma cases from 13 Level I trauma centers, reported that 86.4% of patients were managed nonoperatively, while open surgical intervention was required in only 3.9% of cases.[24] Minimally invasive approaches, including DJ stent placement for urinary extravasation or urinoma formation and selective angioembolization for persistent bleeding, may facilitate renal preservation in appropriately selected patients.[25,26] Although nephrectomy rates have decreased over time, surgical exploration remains necessary in selected patients with hemodynamic instability or severe injuries requiring operative management.[27,28]
In our cohort, 75% of patients were managed conservatively, in line with the organ-preserving approach reported in the literature. In a high-grade injury with limited contrast extravasation, DJ stent placement for urinoma resulted in clinical improvement without the need for more invasive surgery. Similarly, selective angioembolization was successfully performed in 3 hemodynamically stable patients with persistent bleeding, without subsequent surgical intervention. Although nephrectomy was required in 2 hemodynamically unstable patients, no mortality occurred. Overall, these findings demonstrate favorable outcomes with an organ-preserving management strategy in this cohort, in which conservative management was the predominant approach, minimally invasive interventions were used selectively, and surgery was reserved for patients requiring operative management.
Our subgroup analysis comparing low-grade and high-grade injuries demonstrated that injury severity is associated with the clinical course in pediatric isolated renal trauma. Higher-grade injuries had greater transfusion requirements and higher rates of invasive intervention, whereas the majority of low-grade injuries were managed conservatively. These findings are consistent with previous studies reporting injury grade as a parameter influencing the treatment approach in pediatric renal trauma.[21,22] Although the median length of hospital stay was longer in patients with high-grade injuries, this difference did not reach conventional statistical significance. Nevertheless, the observed numerical difference may be clinically relevant, and the lack of statistical significance may partly reflect the small subgroup sizes and limited statistical power rather than the absence of an association. When our results are evaluated in light of the literature, low-grade injuries in hemodynamically stable patients can be safely managed conservatively, whereas high-grade injuries more frequently require minimally invasive interventions. Therefore, it can be concluded that closer clinical monitoring may be necessary, particularly in high-grade injuries, due to potential complications.
Long-term outcomes following pediatric blunt renal trauma are generally favorable, with preserved renal function and low complication rates.[29] Studies indicate that creatinine levels remain within normal limits in most hemodynamically stable children managed conservatively, while persistent hypertension is rare and hematuria typically resolves during follow-up.[30] Long-term morbidity is mainly associated with high-grade injuries and concomitant systemic trauma.[31] Even in high-grade injuries, long-term hypertension and permanent renal dysfunction appear to be uncommon.[32]
Our follow-up findings are consistent with these reports. Creatinine levels remained stable and within normal limits at 1, 3, and 12 months. Urinalysis was normal in all patients at 3 and 12 months, and no persistent hypertension was observed. The mean differential renal function of the injured kidney was 49.34 ± 1.8% on third-month DMSA scintigraphy, indicating substantial preservation of its functional contribution. These findings indicate favorable preservation of renal function and clinical parameters during follow-up in this cohort of pediatric patients with isolated blunt renal trauma.
In our cohort, the imaging strategy differed between the acute/early post-trauma period and the scheduled 3-month follow-up. During the acute and early period, repeat cross-sectional imaging was used selectively in clinically stable patients with low-grade injuries, in accordance with efforts to minimize unnecessary radiation exposure in children and the as low as reasonably achievable (ALARA) principle.[33,34] In contrast, at the 3-month follow-up, contrast-enhanced CT and DMSA scintigraphy were routinely performed in patients who had not undergone nephrectomy as part of the institutional follow-up protocol, providing complementary anatomical and functional assessment. Thus, the ALARA-related approach in our cohort primarily applied to limiting unnecessary repeat imaging during the acute and early post-trauma period rather than to the entire follow-up protocol.
This study has several limitations. Its retrospective design may have limited data completeness and introduced potential selection bias. In addition, because only pediatric patients with isolated blunt renal trauma managed by the Department of Urology were included, the study population may not fully represent the broader spectrum of pediatric renal trauma encountered in routine clinical practice, particularly patients with multisystem injuries or those managed by other surgical specialties. Although this approach reduced clinical heterogeneity and enabled a more focused evaluation of renal injury-specific clinical outcomes, it may limit the external validity and generalizability of our findings. Furthermore, the single-center nature and relatively small sample size may further restrict the generalizability of the results. In addition, as our institution is a tertiary referral center serving a broad geographic region, referral bias cannot be excluded and may have influenced the clinical characteristics and injury severity distribution of the study population. As the analyses were limited to univariable comparisons, potential confounding factors such as age, mechanism of injury, and baseline injury severity could not be adjusted for and may have influenced the observed associations. Moreover, the relatively small numbers of patients in the low- and high-grade injury subgroups may have resulted in unstable estimates and increased the risk of both type I and type II statistical errors; therefore, particularly the nonsignificant subgroup findings should be interpreted with caution. Additionally, the 12-month follow-up period may limit the assessment of rare late complications, such as delayed-onset hypertension.
Nevertheless, our study has important strengths. By focusing exclusively on pediatric patients with isolated blunt renal trauma, we reduced the clinical heterogeneity associated with concomitant multisystem injuries and enabled a more focused evaluation of renal injury-specific clinical and functional outcomes. Systematic follow-up at 1, 3, and 12 months allowed reliable evaluation of long-term results. Objective functional data from CT and DMSA scintigraphy at 3 months further supported not only clinical recovery but also functional preservation. Moreover, the selective use of repeat cross-sectional imaging during the acute and early post-trauma period, particularly in clinically stable patients with low-grade injuries, was consistent with the ALARA principle. Collectively, our findings contribute meaningful evidence supporting conservative, guideline-based, and patient-centered management in pediatric isolated blunt renal trauma.
5. Conclusion
In this study, conservative management was associated with favorable clinical and functional outcomes in appropriately selected pediatric patients with isolated blunt renal trauma. A hemodynamic stability–guided and patient-centered approach was used, with selective repeat imaging during the acute and early post-trauma period and scheduled anatomical and functional assessment at 3 months. Minimally invasive interventions were selectively applied in patients requiring additional management, while surgery was reserved for those requiring operative treatment. Although high-grade injuries were associated with a more complex clinical course, renal function remained preserved during follow-up. Overall, these findings are consistent with and support current guideline-based organ-preserving management strategies in appropriately selected pediatric patients with isolated blunt renal trauma.
Author contributions
Conceptualization: Saban Oguz Demirdogen, Ahmet Emre Cinislioglu, Yilmaz Aksoy, Ozkan Polat.
Formal analysis: Saban Oguz Demirdogen, Ahmet Emre Cinislioglu.
Methodology: Saban Oguz Demirdogen, Ahmet Yildiz, Fahri Aydin.
Project administration: Saban Oguz Demirdogen.
Visualization: Erdem Koc, Fahri Aydin.
Data curation: Tugay Aksakalli, Volkan Kurdal, Ahmet Yildiz.
Investigation: Tugay Aksakalli, Volkan Kurdal, Ahmet Yildiz.
Resources: Yilmaz Aksoy, Ozkan Polat.
Supervision: Yilmaz Aksoy, Ozkan Polat.
Writing – original draft: Saban Oguz Demirdogen, Ahmet Emre Cinislioglu.
Writing – review & editing: Erdem Koc, Yilmaz Aksoy, Ozkan Polat.
Abbreviations:
- AAST
- American Association for the Surgery of Trauma
- ALARA
- as low as reasonably achievable
- CT
- computed tomography
- DJ Stent
- Double J Stent
- DMSA
- dimercaptosuccinic acid
- IQR
- interquartile range
The authors have no funding and conflicts of interest to declare.
The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.
How to cite this article: Demirdogen SO, Cinislioglu AE, Koc E, Aksakalli T, Kurdal V, Yildiz A, Aydin F, Aksoy Y, Polat O. Outcomes of conservative and minimally invasive management in pediatric isolated blunt renal trauma: A retrospective cohort study. Medicine 2026;105:41(e51042).
Contributor Information
Ahmet Emre Cinislioglu, Email: emrecinisli@hotmail.com.
Erdem Koc, Email: drerdemkoc@gmail.com.
Tugay Aksakalli, Email: tugay_daydreamer@hotmail.com.
Volkan Kurdal, Email: vkurdal@gmail.com.
Ahmet Yildiz, Email: ahmetyildiz88@icloud.com.
Fahri Aydin, Email: fhraydn@gmail.com.
Yilmaz Aksoy, Email: aksoyyilmaz@yahoo.com.
Ozkan Polat, Email: opolat@atauni.edu.tr.
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