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NDT Advance Access published online on September 3, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp434
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© The Author 2009. Published by Oxford University Press [on behalf of ERA-EDTA]. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Renal biopsies in children: current practice and audit of outcomes

Farida Hussain1, Meeta Mallik1, Stephen D. Marks2, Alan R. Watson1 and on behalf of the British Association of Paediatric Nephrology*

1 Children's Renal & Urology Unit, Nottingham University Hospitals, Nottingham, UK 2 Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK

Correspondence and offprint requests to: Alan R Watson; E-mail: judith.hayes{at}nuh.nhs.uk



  Abstract

Background. There is considerable variation in the way that children are prepared for and the techniques employed in a renal biopsy. There was national agreement between UK paediatric renal centres to review current practice and audit outcomes

Methods. An initial questionnaire survey was undertaken and a 12-month prospective audit performed of renal biopsies against agreed standards for the number of needle passes, adequacy of biopsy material and complication rates.

Results. Eleven of 13 centres participated. Information leaflets are sent pre-biopsy in five centres with only one using play preparation. Six of 11 routinely perform biopsies as day-case (DC) procedures and 6 use general anaesthesia (GA). Real-time ultrasound is the favoured method in eight centres. Biopsies are performed by nephrologists only in four centres, nephrologists with radiologists in five and radiology alone in two. Of 531 biopsies (352 native), 31% were performed as a DC with 49% being done under GA.

 The standard for the number of passes of native kidneys (≤3 in 80%) was achieved in 86.4%, but the standard of ≤2 passes in 80% was achieved in only 73.4% of transplanted kidneys. Adequate tissue was obtained for diagnosis in 97.5% (standard >95%). The major complication rate was higher than the standard of ≤5% at 10.4%. There was no significant difference in complication rates when the biopsy was performed as a DC or inpatient procedure (P = 0.73) or when GA or sedation was used (P = 0.8).

Conclusions. 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.

Keywords: audit; day-case procedures; renal biopsy; standards

* List of the participating centers is given in the Appendix.

Received for publication: 26. 2.09
Accepted in revised form: 4. 8.09


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