Behandeling van stomp nierletsel bij kinderen

• In 90% of children, blunt abdominal trauma is the cause of renal, splenic or hepatic injury or an injury affecting a combination of these organs.
• Because children’s kidneys are anatomically less protected than those of adults, potential renal injury following direct trauma affecting the child’s flank, for example by a handlebar or knee should be considered.
• Symptoms of renal trauma include excoriations or haematoma on the flank, a ’seatbelt-sign’, macroscopic haematuria and fractures of the ribs and vertebra.
• As haematuria does not correlate with the severity of renal injury, all children with persistent haematuria should undergo renal imaging.
• Children without abnormalities on Doppler ultrasound examination and without macroscopic haematuria can be discharged from the emergency room.
• Conservative management of blunt renal trauma is indicated for all haemodynamically stable children. However, haemodynamically unstable children need to undergo an urgent laparotomy. The routine use of bed rest is only indicated for grade V renal injuries.
• A DMSA scan is recommended 6-12 weeks after trauma for grade IV-V renal injury.

Conflict of interest and financial support: none declared.