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

Background

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.

Methods

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.

Results

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.

Conclusions

Percutaneous renal biopsy remains a safe procedure in children, thus improving family-centered service provision in the UK.

     

A comparison of contemporary definitions of contrast nephropathy in patients undergoing percutaneous coronary intervention and a proposal for a novel nephropathy grading system

Contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) has multiple definitions. We attempted to identify the optimal definition of CIN. In 985 patients undergoing PCI (derivation group), we assessed the prognostic significance of 4 commonly used contemporary definitions of CIN (increases in serum creatinine after PCI [deltaCr] >1.0 mg/dl, >0.5 mg/dl, and >25% after PCI; and the American College of Cardiology National Cardiovascular Data Registry definition) with respect to 6-month major adverse cardiovascular events (MACEs) and all-cause mortality (at 863 +/- 324 days). Incidence of CIN ranged widely (2.0% to 15%) depending on the definition used. Only 2 definitions (deltaCr >0.5 mg/dl, >25%) consistently correlated with study outcomes. Using these 2 definitions, we devised a new grading system (grade 0 deltaCr 25% but 0.5 mg/dl). Nephropathy grades (0 vs 1 vs 2) showed significant correlation with 6-month MACEs (12.4 vs 19.4 vs 28.6%, p = 0.003) and all-cause mortality (10.2 vs 10.4 vs 40.9%, p <0.0001). In multivariate analyses, the grading system showed an independent association with MACEs and mortality. The prognostic value of nephropathy grades was prospectively confirmed in an independent validation group of 539 patients. In conclusion, of the 4 contemporary definitions of CIN, only deltaCr >25% and >0.5 mg/dl consistently predicted adverse events after PCI. By unifying these 2 definitions, we devised a novel nephropathy grading system that is predictive of 6-month MACEs and all-cause mortality after PCI.     

'We just don't know': ambivalence about treatment strategies in the Australian community-based HIV media

The community-based HIV media in Australia provide a unique arena for the negotiation of competing models of medicine between activists, clinicians, government and people living with HIV/AIDS. This article examines how these media have interpreted developments in HIV treatment strategies since the introduction of new treatments in 1996, and identifies the discursive elements employed in journalistic constructions of the temporality and character of HIV medicine. A discourse of ambivalence recurs throughout this journalism, framing the negotiated shifts in treatment strategies as evidence of the uncertainty and unpredictability of HIV medicine. Associated with this discourse are metaphors of medical ambivalence that employ provocative imagery such as fashion, rollercoaster, obstacle course and guessing game to shore up a notion of the volatility of HIV medicine. This article participates in ongoing engagements between the communities and clinicians affected by HIV/AIDS and, more broadly, in the production of knowledge around medicine and the media.     

Current assessment of microhematuria and leukocyturia

Technical advances in laboratory testing such as sensitive chemical tests and standardized commercial slides have significantly altered our entire approach to urinalysis. In addition, the recognition of the association of microhematuria with urologic neoplasms and the morphologically altered red blood cells with renal parenchymal bleeding is beginning to expand our knowledge of the pathogenesis of microhematuria. Future trends may include a broader range of chemical tests as well as a better understanding of disease processes associated with microhematuria.     

Effects of a six-week drug holiday on symptom status, relapse, and tardive dyskinesia in chronic schizophrenics

We have conducted a 6-wk drug withdrawal study in a group of chronic schizophrenic outpatients who had been maintained on injectable fluphenazine decanoate for at least 2 yr prior to the study. After two baseline assessments, patients were randomly assigned to two groups. The first group (holiday) received a placebo injection from a nurse who was not involved in the assessment (N = 17). The second group continued on their regular medication (N = 14). The assessment was done in a double-blind fashion at 3 and 6 wk using the Schedule for Affective Disorders and Schizophrenia (SADS) and the Global Assessment Scale (GAS) inventories to assess symptom status. Tardive dyskinesia was measured using the Abnormal Involuntary Movement Scale (AIMS). Community adjustment was assessed by means of the self-rated Weissman Social Adjustment Scale. We found that there were no relapses of any kind in either group of patients using the instruments mentioned above. The prevalence of tardive dyskinesia as measured by the AIMS was low, with only one patient having severe tardive dyskinesia. There was no significant worsening of the tardive dyskinesia during the drug holiday. Our study concludes that a 6-wk drug holiday was safe in this group of chronic schizophrenic patients maintained on fluphenazine decanoate. In contrast to other studies, no cases of covert tardive dyskinesia were detected during the drug holiday.     

Determination of N-(2-benzoyloxyethyl)-norfenfluramine (JP 992) and its metabolites in urine

A gas-liquid chromatographic method of determination of norfenfluramine and N-2-hydroxyethylnorfenfluramine is described. Also a method is reported to determine N-(2-benzoyloxyethyl)norfenfluramine and its metabolites containing the m-trifluoromethyl- benzyl and -benzoyl moieties in urine, by oxidation of these to m-trifluoromethyl benzoic acid followed by methylation and gas-liquid chromatography.