Management Strategies and Outcomes of Pediatric Renal Trauma: A Systematic Review and Meta-analysis

Abstract

Background: Pediatric renal trauma represents a large proportion of genitourinary injuries in children and is most often related to blunt abdominal trauma sustained in motor vehicle collisions, falls, sports injuries, and bicycle accidents. Imaging modalities, trauma care, and minimally invasive interventions have evolved, and the management strategies have changed from operative treatment to conservative approaches. Recent investigations have demonstrated the success of nonoperative management in the majority of hemodynamically stable pediatric patients, including some high-grade renal injuries. Objective: To systematically review and meta-analyze published studies to assess current diagnostic approaches, management strategies, and clinical outcomes of pediatric renal trauma. Methods: A systematic review meta-analysis was conducted according to PRISMA guidelines. Electronic databases including PubMed, Scopus, Web of Science, and Google Scholar were searched for studies published between 2013 and 2026. Studies were eligible if they included pediatric patients with renal trauma and reported management strategies, imaging findings, complications, or clinical outcomes. Pooled proportions and effect estimates were calculated using a random effects model. Heterogeneity was assessed with the I² statistic and Cochran’s Q test. Results The primary outcomes were renal preservation, success of nonoperative management, complications, and nephrectomy rates. Results: The systematic review comprised 31 studies with 3482 pediatric patients with renal trauma; 18 studies were eligible for quantitative meta-analysis. Injury was most commonly due to blunt trauma (pooled proportion: 89.4%; 95% CI: 84.1–93.1; I2 = 58%). Low-grade renal injuries (AAST grades I-III) were the most common injury pattern. The pooled success rate of nonoperative management was 93.2% (95% confidence interval [CI]: 89.7–95.6; I2 = 42%). Renal preservation was achieved in 96.1% (95% CI: 93.4–97.8; I2 = 37%). Children with high-grade injuries who are hemodynamically stable and managed conservatively have favorable outcomes with significantly lower rates of nephrectomy than operative management (pooled OR: 0.28; 95% CI: 0.14–0.56; p < 0.001). The overall complication rates were low (11.6%; 95% CI: 8.2–16.1; I² = 49%) with urinoma, hematuria, and urinary extravasation being the most common complications reported. The use of minimally invasive procedures such as ureteral stenting and angioembolization increased in the management of complications with improved renal salvage rates. Conclusion: The evidence available strongly promotes the use of conservative and minimally invasive management as the treatment of choice in most pediatric renal trauma cases, especially in hemodynamically stable patients. These strategies have been associated with high rates of renal preservation, low rates of complication, and significantly reduced rates of nephrectomy, thereby improving overall clinical outcomes.