Aims The current national drive to build robust paediatric nephrology networks recommends services cater for the needs of the family and minimise time away from the home¹. Families often have to travel some distance to a tertiary centre for renal biopsies. It is recognised that performing renal biopsies as a daycase procedure reduces stress and disruption for patients and their families whilst enabling cost saving². Despite this only half of UK paediatric nephrology centres offered the procedure as a daycase in 2005³. Access to pre-procedure written information, play therapy and distraction is beneficial in preparing patients and families for invasive procedures ^4,5.

This national survey and re-audit of paediatric renal biopsies in the UK sought to identify changes in practice since the last national audit in 2005 and how these compared the the national BAPN standards¹.

Methods A preliminary survey was sent to all 14 UK paediatric nephrology centres to identify current routine practice, including information relating to the provision of information leaflets, play preparation and daycase procedures. A prospective national audit was undertaken at participating centres between January and June 2012. Data was audited against BAPN standards and results were compared to finding from the preceding audit in 2005³.

Results Survey results from 11 of the UK paediatric nephrology centres showed play preparation was provided in 90.9% of centres compared to 9.1% in 2005. Pre-procedure information leaflets were offered in 63.6% (2012) of centres compared to 45.5% (2005).

A total of 331 renal biopsies were then audited from twelve UK centres between January and June 2012. The proportion of daycase procedures increased from 32.9% (2005) to 49.5% (2012). There was no significant increase in complication rate associated with this change (P = 0.78).

Conclusion This national re-audit highlights encouraging changes in practice which demonstrate a commitment to ensuring children are well prepared for procedures and efforts are made to minimise impact on family life through reducing time spent away from home. Recommendations to further improve pre-procedure information for families will include the generation of on-line national renal biopsy leaflets. Such service improvements will remain key to the national drive to improve paediatric nephrology networks¹.

References

1. Improving the standard of care of children with kidney disease through paediatric nephrology networks. Report of a working party of Royal College of Paediatrics and Child Health, British Association for Paediatric Nephrology and NHS Kidney Care. August 2011.

2. Chesney D, Brouhard B, Cunningham R. Safety and cost effectivenessof pediatric percutaneous renal biopsy. Pediatr Nephrol 1996; 10:493–495.

3. Hussain F, Malik M, Marks SD, Watson AR. Renal biopsies in children: current practice and audit of outcomes. Nephrol Dial Transplant. 2010; 25: 379–80.

4. Uman LS, Birnie KA, Noel M, Parker JA, Chambers CT, McGrath PJ, Kisely SR. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD005179. DOI: 10.1002/14651858. CD005179.pub3.

5. LeRoy S, Elixson ME, O’Brien P, Tong E, Turpin S, Uzark K. AHA Scientific Statement:Recommendations for Preparing Children and Adolescents for Invasive Cardiac Procedures: A Statement From the American Heart Association Pediatric Nursing Subcommittee of the Council on Cardiovascular Nursing in Collaboration With the Council on Cardiovascular Diseases of the Young. Circulation. 2003;108:2550–2564,doi:10.1161/01. CIR.0000100561.76609.64