A Systematic Review for Guidelines: Sports and High-Grade Kidney Injuries in Children With Solitary Kidneys

Abstract

Aim: To determine the risk of Grades IV and V kidney injury due to common children's sports. Methods: A systematic review of studies reporting traumatic kidney injuries (TKIs) associated with basketball, cycling, equestrian, motorsports, netball, rugby, Australian football or soccer. Studies with patients exclusively 18 years or older, non-TKIs or non-sport-related mechanisms were excluded. Results: Twenty-five studies with 24 424 patients were included. The estimated risk of kidney loss from sports injuries is 0.37 per million child-years. However, the incidence of Grades IV and V injuries could not be calculated in at-risk populations due to limited prospective data. The prevalence of TKIs from sport-specific trauma was low, ranging from 0.6% to 2.2%. Few studies graded the severity of kidney injury, but in the small number reported, Grades IV and V injuries occurred in 33% of soccer TKIs, 26% of bicycling, 23% of Australian football, 20% of basketball and 17% of equestrian injuries. The high number of ungraded kidney injuries (5514/5607) impacts the reliability of findings. Conclusion: Recommendations to exclude children with congenital single kidneys from specific sports lack a firm evidence-base. Given bio-psycho-social consequences, such recommendations must be carefully considered, particularly for equestrian and motorised vehicles, which carry a higher risk of trauma.