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Audit on the practice of kidney biopsies in children
  1. P Kandaswamy1,
  2. S Hegde2,
  3. R Jeganathan1
  1. 1Nevill Hall Hospital, Aneurin Bevan Health Board, Abergavenny, UK
  2. 2University Hospital of Wales, Cardiff and Vale NHS Board, Cardiff, UK

Abstract

Introduction Practice of diagnostic percutaneous renal biopsy in children has considerable variation in different centres in UK. We reviewed our practice and compared it against the standards recommended by the British Association of Paediatric Nephrologists (BAPN).

Methods We retrospectively analysed the medical case notes and hospital pathology web browser to collect data of all patients who had kidney biopsies performed in our unit over a 2 years period starting from Jan 2008 until Dec 2009.

Results Out of total 31 biopsies performed in 28 patients, 21 were of native kidneys and rest consisted of renal transplants. All the biopsies were done by consultant nephrologists with real time ultrasound guidance except in one patient needing assistance from the consultant radiologist. Biopsies were performed as a day case procedure in 84% of patients. 64% of biopsies were done under sedation, 13% using local anaesthesia and 23% under general anaesthesia. The common complications noted in our audit were macroscopic haematuria (6.4%) and readmission (3.2%).

The most common indication for biopsy in the native kidney was proteinuria in 47.6% patients and suspected drug toxicity in 23.8%. Suspected rejection was the main indication for transplanted kidneys. The commonest biopsy finding in nephrotic syndrome was minimal change disease (38.1%). Among the patients with glomerulonephritic picture, the most common primary cause was membrano-proliferative type and henoch-schoenlein purpura was the commonest secondary cause.

The standard for the number of needle passes for native kidneys (≤3 in 80%) was achieved in 86% and for transplants (≤2 passes) in 80%. Adequate tissue was obtained for diagnosis in 97% (standard >95%) and the major complications rate was only 3.2% (standard ≤5%).

Conclusion The study showed that the standards for renal biopsy as recommended by BAPN were achieved in the unit. We recommended that in day cases, intravenous hydration was not mandatory and it was safe to discharge after at least 6-8 hours of observation following biopsy. We also suggested improving our documentation in inpatient notes and including a renal biopsy check list.

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