MURAT BAĞCIOĞLU, Mehmet USLU, SUNAY SİBEL KARAYOL, RAMAZAN KOCAASLAN, Ümit Yener TEKDOĞAN

Konservatif yaklaşım uygulanan Grade IV künt böbrek travmasının uzun dönem sonucu: Olgu sunumu

Pediatrik hasta grubunda düşük dereceli böbrek yaralanmalarına yaklaşımda konservatif yaklaşım yaygın ve bilinen bir stratejidir. Yüksek dereceli böbrek hasarlarında ise eksplorasyon önerilmektedir. Ancak, özellikle çocuk yaş grubundaki hastalarda, üriner ekstravazasyonun eşlik ettiği yüksek dereceli böbrek yaralanması olan olgularda, yatak istirahati ve üretral kataterizasyonu içeren konservatif yaklaşımın erken ve uzun dönemde herhangi bir komplikasyona neden olmadan, böbrek parankim hasarı olmadan tam iyileşme ile sonuçlanabileceği akılda tutulmalıdır. Yüksek dereceli böbrek yaralanmalarına yaklaşım son yıllarda konservatif yöntem lehine değişim içinde olsa da hemodinamik insitabilitenin olduğu vakalarda ise geleneksel eksplorasyon yöntemine başvurulmalıdır.

Anahtar Kelimeler:

böbrek yaralanması, konservatif yaklaşım, prognoz.

Long term outcome of conservatively managed grade iv blunt kidney trauma

A conservative approach to low grade kidney injuries in the pediatric patient population is a commonly employed and well-known strategy. In cases of high grade renal damage, exploration is recommended. However, it should be kept in mind that, particularly in the pediatric age group, high grade renal injury cases accompanied by urinary extravasation can be concluded with complete resolution when treated with a conservative approach including bed-rest and urethral catheterization; in the short- or long-term without any complications or damage to the renal parenchyma. Even though approaches to higher grade kidney injuries in recent years have been in favor of a conservative approach, in cases of hemodynamic instability, the traditional exploration method is recommended

Keywords:

renal injury, conservative management, prognosis,

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1. Wright JL, Nathens AB, Rivara FP, Wessells H. Renal and extrarenal predictors of nephrectomy from the national trauma data bank. J Urol 2006;175:970-975.
2. Brown SL, Elder JS, Spirnak JP. Are pediatric patients more susceptible to major renal injury from blunt trauma? A comparative study. J Urol 1998;160:138-140.
3. McGuire J, Bultitude MF, Davis P, et al. Predictors of outcome for blunt high grade renal injury treated with conservative intent. J Urol 2011;185:187-191.
4. Peclet MH, Newman KD, Eichelberger MR, et al. Patterns of injury in children. J Pediatr Surg 1990;25:85-90.
5. Wessel LM, Scholz S, Jester I, et al. Management of kidney injuries in children with blunt abdominal trauma. J Pediatr Surg 2000;35:1326-1330.
6. Margenthaler JA, Weber TR, Keller MS. Blunt renal trauma in children: experience with conservative management at a pediatric trauma center. J Trauma 2002;52:928-932.
7. Rogers CG, Knight V, MacUra KJ, et al. High-grade renal injuries in children--is conservative management possible? Urology 2004;64:574-579.
8. Fiard G, Rambeaud J-J, Descotes J-L, et al. Long-term renal function assessment with dimercapto-succinic acid scintigraphy after conservative treatment of major renal trauma. J Urol 2012;187:1306-1309.
9. Cass AS, Luxenberg M, Gleich P, Smith C. Long-term results of conservative and surgical management of blunt renal lacerations. Br J Urol 1987;59:17-20.
10. Danuser H, Wille S, Zöscher G, Studer U. How to treat blunt kidney ruptures: primary open surgery or conservative treatment with deferred surgery when necessary? Eur Urol 2001;39:9-14.
11. Altman AL, Haas C, Dinchman KH, Spirnak JP. Selective nonoperative management of blunt grade 5 renal injury. J Urol 2000;164:27-31.
12. Santucci RA, McAninch JM. Grade IV renal injuries: evaluation, treatment, and outcome. World J Surg 2001;25:1565- 1572.