The audit highlights significant variation in clinical practice with limited use of preparation materials and DC procedures. The results have stimulated constructive debate about preparation and indications for biopsy and training issues. The audit enables centres and individuals to monitor performance.
There are no national standards for the adequacy and complications of percutaneous renal biopsies. We developed local standards that have been used in a prospective audit of biopsies undertaken in a tertiary pediatric nephrology unit between January 1997 and December 2000. We compared outcomes of biopsies performed on inpatients with day care procedures. A total of 251 biopsies (113 transplant) were undertaken, 114 (46%) as day care procedures. Adequate tissue for diagnosis was obtained in 245 (97.6%), with a standard set at >95%. This was also achieved for a mean number of passes in native (<3 in 80%) and transplanted (<2 in 80%) kidneys. Eleven patients (4%) developed macroscopic hematuria (standard <5%) and none required transfusion. Delay in discharge occurred in 4 patients, and a further 4 returned to the ward post discharge. There was no significant difference in complication rates between inpatient and day care patients. Our local biopsy standards were met in this audit. Such standards could provide useful comparisons between units in national audit programs, as well as permitting the monitoring of individual performance as part of clinical governance. Day care procedures benefit the patient and family, as well as significantly reducing costs.
Anemia is present in a significant proportion of European pediatric kidney transplant recipients and is associated with renal allograft dysfunction and type of immunosuppressants used. In our patient cohort, higher Hb levels were associated with better graft and patient survival and less hypertension.
The incidence of end-stage renal disease in children is increasing. Peritoneal dialysis (PD) is the modality of choice in many European countries and is increasingly applied worldwide. PD enables children of all ages to be successfully treated while awaiting the ultimate goal of renal transplantation. The advantages of PD over other forms of renal replacement therapy are numerous, in particular the potential for the child to lead a relatively normal life. Indications for commencing PD, the rationale, preparation of family, technical aspects, and management of complications are discussed.
Aims: To describe the demographics of the paediatric RRT population in the UK and analyse changes in demographics with time. Methods: Extraction and analysis of data from the UK Paediatric Renal Registry and the UK Renal Registry (UKRR). Results: The UK paediatric established renal failure (ERF) population in December 2008 was 905 patients. The prevalence under the age of 16 years was 56 per million age related population (pmarp) and the incidence 7.4 pmarp. The incidence and prevalence for South Asian patients was much higher than that of the White and Black populations. Renal dysplasia was the most common cause of ERF accounting for 33% of prevalent cases. Diseases with autosomal recessive inheritance were a common cause of ERF in all ethnic groups, 23.5% of prevalent and 18% of incident cases. Whilst the incidence and prevalence of diseases with autosomal recessive inheritance in the South Asian population was 3 times that of the white population, this was not the sole reason for the increased proportion of South Asian patients with ERF, as diseases with no defined inheritance were twice as common in this ethnic group than in White patients. Prevalent mortality stood at 9.4%. Most deaths were in patients presenting with ERF early in life and mortality varied markedly according to the aetiology of ERF. The proportion with new grafts from living donors has steadily risen to 54%. Children from ethnic minority groups were less likely to have an allograft and living donation was less frequent in this population. For those on dialysis, 56% were receiving peritoneal dialysis. This was the main treatment modality for patients under 4 years of age. Conclusions: The paediatric ERF population continued to expand slowly. Incidence and prevalence rates were stable and similar to other developed nations. The high incidence in patients from ethnic minority groups will lead to a greater proportion of the population being from these groups in time. To maintain the high proportion of engrafted patients it will be necessary to encourage living donation in the ethnic minority population. Case note analysis of the factors involved in mortality would be valuable.
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