When water is thicker than blood: recognising a systemic cause of haemoptysis.

The case of an 11-year-old child presenting with acute haemoptysis and breathlessness is described. The girl was Malaysian and had recently arrived in the UK. She subsequently deteriorated, developing respiratory failure. The course of the illness is described, with reference to the diagnostic process at each stage. The case demonstrates the importance of having a broad investigatory approach in acute haemoptysis.

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.

Postnatal outcome of prenatally diagnosed severe fetal renal pelvic dilatation.

OBJECTIVE: We correlated the prenatal severity with the postnatal outcome of prenatally detected renal pelvic dilatation (RPD). METHODS: Cases of prenatally detected RPD referred between January 2002 and December 2008 were included. Severe RPD was defined as an anterior-posterior diameter of 15 mm, mild and moderate dilatation was defined as 6 to <10 mm and 10 to <15 mm, respectively. Postnatal diagnosis, the need for surgery and the correlation with the prenatal severity was ascertained. RESULTS: Of the 762 patients with RPD, 492 (64.5%) were mild, 167 (21.9%) were moderate, and 103 (13.5%) were severe. The male:female ratio for the severe cohort was 5:1. Of the sever cases, 68% had progressive dilatation. Of the mild/moderate cases, 5% progressed to severe dilatation. PUJ obstruction was confirmed in 48 cases (60.8%), severe VUR in 11 cases (14%), VUJ obstruction in 5 cases (6%), PUV in 2 cases (2.5%), and a nonidentifiable cause in 13 cases (16.5%). Ten of the 48 (20.8%) babies with PUJ obstruction required surgery within the first year of life. CONCLUSION: An obstructive cause is usually present in severe cases, which are more likely to require surgery if there is PUJ obstruction. A high male:female ratio was present in this group.