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There is Insufficient Data to Properly Advise the Families of Children with a Solitary Kidney About the Risk of Participating in Sports Activities

Question

  • What advice should physicians give their pediatric patients with a solitary kidney about participating in sports activities?

Clinical Bottom Lines

  1. No clear advice can be given to families of children with a solitary kidney regarding participation in sports activities.
  2. In making recommendations, physicians must also consider the medicolegal implications of participation of children with a solitary kidney in sports activities. This may lead physicians to suggest more limitations on sports participation.


Summary of Key Evidence

  1. There are no studies specifically evaluating risk of sports participation in children with a solitary kidney.
  2. Recreational and team sports accounted for 0.7% of renal injuries in a trauma registry of 14,763 pediatric trauma patients at a level I trauma center with radiographic or physical evidence of renal injury.1
  3. A phone interview as part of the National Health Interview Survey looked at sports injuries in 11840 children and adolescents aged 5 to 17 years over a 12 month period. Renal injuries are not specified. They found a rate of 0.5 contusions /100 children and 0.6 "other injuries"/100 children.2
  4. There are no large studies evaluating specific risk of renal injury during sports participation. A study of 68 renal trauma patients in Cleveland found that bicycle riding was the most common nonmotorized sports related injury in children accounting for 57% of cases.3
  5. Studies in adults have shown that patients with abnormal kidneys are at higher risk for trauma.4

Additional Comments

  • Approximately 1 in 1500 children or adolescents has either a congenital or acquired solitary kidney.
  • The 2001 AAP Guidelines on Medical Conditions affecting sports participation recommend that athletes with the absence of one kidney receive individual assessment prior to participation in contact, collision or limited-contact sports.5
  • A Swiss study of 3609 adolescents ages 10-19 found a higher rate of injury in body building, skate boarding, roller skating, snowboarding, basketball, soccer and ice hockey. All had relative risks greater than 1.2 with CI not crossing one. Renal injuries were not specifically studied or mentioned.6

Citation

  1. Gerstenbluth RE, Spirnak JP, Elder JS. Sports participation and high grade renal injuries in children. J Urol 2002; 168:2575-8.
  2. Bijur PE, Trumble A, Harel Y, et al. Sports and Recreation Injuries in US Children and Adolescents. Arch Pediatr Adolesc Med 1995; 149:1009-16.
  3. McAleer IM, Kaplan GW, LoSasso BE. Renal and Testis Injuries in Team Sports. J Urol 2002; 168:1805-7.
  4. Schmidlin, FR, Iselin CE, Naimi A, et al. The Higher Injury Risk of Abnormal Kidneys in Blunt Renal Trauma. Scand J Urol Nephrol 1998; 32:388-392.
  5. American Academy of Pediatrics, Committee on Sports Medicine and Fitness. Medical conditions affecting sports participation. Pediatrics 2001; 107:1205.
  6. Michaud PA, Renaud A, Narring F. Sports activities related to injuries? A survey among 9-19 year olds in Switzerland. Injury Prevention 2001; 7:41-5.

CAT Author: Lauren Cayton Boyd, MD

CAT Appraisers: Robert Schumacher, MD

Date appraised: October 22, 2003

Last updated December 24, 2003
Department of Pediatrics and Communicable Diseases
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