Traumatismul renal la copil

Abstract

The objective of the study. Renal traumas are a permanent challenge for physicians, obliging them to find new diagnostic and therapeutic solutions, that lead to continuous improvement of life quality. This challenge led to an application of advanced technics of imaging investigation for an accurate determination of renal trauma, before exploring it clinically. In some patients, a nonspecific and variable clinical picture of renal trauma impedes its diagnostics. A case of renal trauma diagnosed and treated surgically with a positive outcome in our clinic is described below. Materials and methods: Here is a case history of a 14-year-old patient without any previous history, who had not been treated medicinally until he suffered a renal trauma. The patient with risk factor - hemorrhage was transferred from the Regional Hospital to Academician Natalia Gheorghiu National Scientific and Practical Centre of Pediatric Surgery, PHI Institute of Mother and Child’s, for the treatment. The patient underwent surgical intervention. As the kidney was crushed with an affected renal pedicle, a nephrectomy was performed. The patient’s decapsulated kidney, removed during the surgery, was sampled for macroscopic morpho-pathological study using the method of morphometry (organometry and macrometry). The morphometry data were compared with the average norm for adolescents aged 14. Tissue samples taken from lesions of the renal parenchyma and adjacent tissues were examined histo-morphologically and later processed using automated histological processing and hematoxylin staining method. Results: The results of the study revealed that the kidney lesioned severely revealed that the trauma developed in the kidney that was anatomically and morphologically compliant with the patients' age, and in the absence of any previous pathology. The lesion was attested to be of a severe degree. It was revealed that in children in lesions produced by closed injuries the kidney undergoes not only severe lesions due to combined ruptures with involvement of the caliceal system but also of a renal parenchyma major contusion supplemented with diverse intensity and spread of hemorrhagic changes localized both at the level of rupture and in adjacent tissues. These lesions are commonly associated with aseptic ischemic and necrotic changes that within 52 hours cause the evolution of both necrotic and thrombotic changes and the development of inflammatory process attested by a discreet focal lymphocytic and leucocytic infiltration.