TOPLINE

Most children with low-grade renal injuries received nonoperative management. Among those with high-grade renal trauma, rates of nephrectomy were around 5%, and among those who received kidney-sparing interventions, angioembolization was more effective than surgical repair at preventing further bleeding interventions.

METHODOLOGY

• Researchers analyzed data from an incident-based trauma registry, including 15,138 pediatric patients (mean age, 13.7 years; 69% male individuals; 62% White) with renal injuries between 2013 and 2022.
• The severity of injury was categorized according to a grading scale, with grades III-V classified as high-grade renal trauma.
• Management strategies were classified as bleeding interventions (renal angioembolization, nephrectomy, or surgical repair), collecting interventions (the use of nephrostomy tube, perirenal drain, or ureteral stent), or nonoperative (the absence of bleeding and collecting interventions).
• Procedure success was defined as angioembolization or surgical repair without subsequent bleeding intervention, whereas failure was defined as receiving a second bleeding intervention after the initial intervention.

TAKEAWAY

• Around 90% of all cases and 98% of low-grade renal injuries received nonoperative management. This type of treatment use decreased slightly over the decade (P < .001), primarily due to an increase in the use of renal angioembolization in 2021 and 2022; the use of nephrectomy and surgical repair remained stable.
• Factors significantly associated with decreased odds of receiving nonoperative management included penetrating trauma (P < .001), blood transfusion (P < .001), and treatment at adult facilities (P = .03), whereas isolated kidney injury was associated with increased odds (adjusted odds ratio, 1.95; P = .002).
• Among cases of high-grade renal trauma, 5.8% underwent nephrectomy. Of the 474 cases that received kidney-sparing interventions, procedure success was achieved in 87% of angioembolization cases (n = 294) vs 81% of surgical repair cases (n = 180).
• Death occurred in 4.3% of patients, of whom 99% had non-kidney injuries. Only two patients with isolated injuries had high-grade renal trauma. Patients who died were more likely to present with shock and to receive blood transfusion (P < .001 for both).

IN PRACTICE

“Almost all cases of low-grade pediatric renal trauma were managed expectantly in this study. In high-grade injuries, decision for intervention/nephrectomy are likely influenced by factors including renal injury grade, hemodynamic factors, other organ injuries, patient age, and provider preference, indicating that some can be avoidable,” the authors wrote.

SOURCE

The study was led by Nizar Hakam of the Department of Urology at the University of California, San Francisco. It was published online on June 17, 2026, in The Journal of Urology.

LIMITATIONS

Data entry errors may be possible and information on important variables such as imaging results, laboratory tests, and long-term outcomes were lacking. Treatment intent was not captured in the registry.

DISCLOSURES

No funding was received for this work. The authors did not disclose any relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.