|
UROGENITAL
TRAUMA
Single
Kidney and Sports Participation: Perception versus Reality
Grinsell MM, Showalter S, Gordon KA, Norwood VF
Department of Pediatrics, Division of Nephrology, University of Virginia,
Charlottesville, Virginia, USA
Pediatrics. 2006 Sep;118(3):1019-27
- Objectives:
Physician opinions and practice patterns regarding the participation
of children and adolescents with single, normal kidneys in contact/collision
sports are widely varied. We hypothesize that limitation of participation
from play based only on the presence of a single kidney is not supported
by available data. We sought to determine recommendations of pediatric
nephrologists regarding the participation of patients with single, normal
kidneys in contact/collision sports and review the literature to determine
the rate of sports-related kidney injury compared with other organs.
-
Methods:
Members of the American Society of Pediatric Nephrology were surveyed
regarding their recommendations for participation of patients with single,
normal kidneys in contact/collision sports. Medical and sports literature
databases were searched to determine sports-related kidney, brain, spinal
cord, and cardiac injury rates and the sports associated with kidney
injury.
- Results:
Sixty-two percent of respondents would not allow contact/collision sports
participation. Eighty-six percent of respondents barred participation
in American football, whereas only 5% barred cycling. Most cited traumatic
loss of function as the reason for discouraging participation. The literature
search found an incidence of catastrophic sports-related kidney injury
of 0.4 per 1 million children per year from all sports. Cycling was
the most common cause of sports-related kidney injury causing > 3
times the kidney injuries as football. American football alone accounted
for 0.9 to 5.3 fatal brain injuries and 4.9 to 7.3 irreversible spinal
cord injuries per 1 million players per year. Commotio cordis causes
2.1 to 9.2 deaths per year.
-
Conclusions: Most
pediatric nephrologists prohibit contact/collision sports participation
by athletes with a single kidney, particularly football. The available
evidence suggests that cycling is far more likely to cause kidney injury.
In addition, kidney injury from sports is much less common than catastrophic
brain, spinal cord, or cardiac injury. Restricting participation of
patients with a single, normal kidney from contact/collision sports
is unwarranted.
- Editorial
Comment
Recommendations for patients who have a solitary kidney and participation
in organized sports and so-called alternative extreme sports is controversial.
Admittedly, children are more likely than adults to sustain renal injury
from blunt abdominal trauma due to kidney relative size and lack of
peri-renal fat and lack of bone and rib ossification. In general, patients
with two normal kidneys and injury to one kidney in an accident or sports
related event, I typically tell these patients to limit their activity
to non strenuous activities and no lifting greater then 20 pounds for
1 to 3 months (1 month for non contact sports and 3 months for contact
sports, such as football). The recommendation of the American Academy
of Pediatrics Committee on Sports Medicine and Fitness is that children
with a solitary kidney should not play team contact sports. However,
what is the true incidence of high-grade renal injuries broken down
by type of sport?
Johnson et al. (1) noted that high-grade injuries and renal loss in
children occurred as a result of motor vehicle accidents, pedestrian
versus motor vehicle and falls. No kidneys were lost to contact sports.
Sledding, skiing and rollerblading resulted in kidney loss. Brown et
al. (2) noted that all high-grade renal injuries resulted from bicycle
accidents and none from team sports. It appears, therefore, that activities
like bicycling, motor-cross, skiing and the like, entail much higher
speed and momentum then contact sports. Thus the mechanism of injury
is much more severe with such activities then with contact sports, and
helps to explain why high-grade injuries are rare with team sports (such
as soccer and football). In conclusion, we feel that recommendations
about participation in team sports and a solitary kidney appear to be
overly protective and need to be re-evaluated with a metanalysis. However,
non-team sports such as sledding, skiing, biking, atving and motorcross
are risky activities for the solitary kidney child.
References
1. Brown S, Elder J, Spirnak J: Are pediatric patients more susceptible
to major renal injury from blunt trauma? A comparative study. J Urol.
1998;160: 138-40.
2. Johnson B, Christensen C, Dirusso S, Choudhury M, Franco I: A need
for reevaluation of sports participation recommendations for children
with a solitary kidney. J Urol. 2005; 174: 686-9.
Dr.
Steven B. Brandes
Associate Professor, Division of Urologic Surgery
Washington University in St. Louis
St. Louis, Missouri, USA |