Conservative management for a pediatric shattered kidney in Dustira Military Hospital: a case report

Link of Video Abstract: https://youtu.be/RgbLNMcOiN0 Background: Pediatric renal trauma is more common than in adults due to distinct anatomical features such as reduced perirenal fat and larger kidney size. Approximately 85–90% of pediatric renal injuries are caused by blunt trauma. One of the most severe forms, a shattered kidney, often presents with deep lacerations, macrohematuria, and urinary extravasation. According to the American Association for the Surgery of Trauma (AAST), renal injuries are graded I to V, with grade V traditionally indicating surgical intervention. However, recent developments emphasize non-operative strategies to preserve renal function, reflecting a paradigm shift in managing high-grade renal trauma. Case Presentation: A 6-year-old boy presented with right-sided back pain and visible hematuria following blunt abdominal trauma. Imaging via contrast-enhanced CT revealed a grade V renal injury characterized by complete renal transection with upper and lower pole separation and contrast extravasation. Despite the severity, the patient underwent successful conservative management, including close monitoring of vital signs, serial hemoglobin levels, and urinalysis. The patient showed continuous improvement and was discharged on the seventh day. One-month follow-up demonstrated normal kidney function, no signs of extravasation, and unremarkable laboratory results. Conclusion: This case supports the viability of conservative management for hemodynamically stable pediatric patients with high-grade (grade V) renal trauma. Successful outcomes can be achieved without surgical intervention through multidisciplinary care and vigilant monitoring.