Positive trends in paediatric renal biopsy service provision in the UK: a national survey and re-audit of paediatric renal biopsy practice.

Abstract

Paediatric renal biopsy standards introduced in the UK in 2010 were intended to reduce variation and improve practice. A concurrent national drive was aimed at building robust paediatric nephrology networks to ensure services cater for the needs of the family and minimise time away from home. We aimed to identify current national practice since these changes on behalf of the British Association for Paediatric Nephrology. All UK paediatric nephrology centres were invited to complete a survey of their biopsy practice, including advance preparation. From 1 January to 30 June 2012, a national prospective audit of renal biopsies was undertaken at participating centres comparing practice with the British Association for Paediatric Nephrology (BAPN) standards and audit results from 2005. Survey results from 11 centres demonstrated increased use of pre-procedure information leaflets (63.6% vs 45.5%, P = 0.39) and play preparation (90.9% vs 9.1%, P = 0.0001). Audit of 331 biopsies showed a move towards day-case procedures (49.5% vs 32.9%, P = 0.17) and reduced major complications (4.5% vs 10.4%, P = 0.002). Biopsies with 18-gauge needles had significantly higher mean pass rates (3.2 vs 2.3, P = 0.0008) and major complications (15.3% vs 3.3%, P = 0.0015) compared with 16-gauge needles. Percutaneous renal biopsy remains a safe procedure in children, thus improving family-centered service provision in the UK.