Natural history of non-operative treatment for renal injuries in children.

AIM: Kidney is one of the solid organs injured in blunt abdominal traumas. Conservative management is well recognized in adults, but is still controversial in children. We performed a retrospective review regarding children with renal injuries observed at our Centre, analyzing the importance of a prompt diagnosis and the role of conservative treatment according to the degree of renal injury and natural history. METHODS: We reviewed 15 cases of blunt abdominal trauma with renal injuries observed during a period of 11 years. The diagnosis was confirmed by abdominal computed tomography (CT) scan and ultrasonography (US). Conservative treatment started monitoring the hemodynamic stability, the hematocrit value, the hemoglobin, the red cell count, the urine analysis. If necessary blood transfusion was performed. A follow-up from 1 month to 2 years monitored the lesions healing. RESULTS: Age of patients varied from 3 to 15 years (mean age = 6.3). Nine were males and six females. Two patients had an associated spleen lesion, thirteen had an isolated renal injury. Injury grades were classified as follows: grade I, 5 cases; grade II, 3 cases; grade III, 5 cases and grade IV, 2 cases. Non operative management was successful in 14 out of 15 cases; 1 patient with grade IV required a partial nephrectomy. At follow-up good healing of the lesions was observed. CONCLUSION: Most of renal injury related to abdominal trauma can be successfully and safely managed conservatively. Hemodynamic stability, a prompt clinical and instrumental diagnosis and grading of lesions by CT are necessary to start an effective non operative treatment.

Early metabolic, functional and histological changes in a rat ileal-augmented bladder model.

OBJECTIVE: An animal model of female Wistar species of rats was developed to study the early effects of ileocystoplasty. MATERIALS AND METHODS: Bladder augmentation using ileum and a sham operation (cistostomy) were performed in 14 and 6 female Wistar rats, rispectively. Urine was obtained for culture and urinalysis in all rats at the time of operation and at the time of the sacrifice. Seven rats underwent ileocystoplasty and three shams were sacrificed after one and three months. In all rats sacrificed three months after ileocystoplasty, blood sample drawn for serum electrolytes, blood urea, nitrogen creatine and bicarbonate was performed. Post mortem histopathological examination of the ileal patch and of kidneys was performed. RESULTS: The cultures of the urine were positive in 1 out 7 (14.3%) and in 4 out 7 (57%) after one and three months after ileocystoplasty, respectively. Urinary pH of the augmented group was significantly higher in treated rats than in shams (p < 0.05). At sacrifice three months post operatively, the serum chloride concentration was significantly higher in augmented than shams (p < 0.05). Bladder calculi were formed in 28.6% of ileocystoplasty. Histopathological examination of the enteropatch showed urothelialization of the graft and kidneys showed a significant glomerular depletion. CONCLUSION: Our data confirm an early significant enhancement of urinary pH in rats underwent ileocystoplasty and the stone formation is a frequent event. Already three months after ileocystoplasty urothelialization extended from the side of anastomosis towards the central portion of the ileal graft. Moreover, a significant improvement of serum creatine, sign of glomerular overload and progressive glomerular depletion were recorded in treated rats, probably as a consequence of water and electrolyte resoption through the intestinal graft.