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Plumb L, Magadi W, Casula A, Reynolds BC, Convery M, Haq S, Hegde S, Lunn A, Malina M, Morgan H, Muorah M, Tyerman K, Sinha MD, Wallace D, Inward C, Marks S, Nitsch D, Medcalf J. Advanced chronic kidney disease among UK children. Arch Dis Child 2022; 107:archdischild-2021-323686. [PMID: 35732469 DOI: 10.1136/archdischild-2021-323686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The UK Renal Registry currently collects information on UK children with kidney failure requiring long-term kidney replacement therapy (KRT), which supports disease surveillance and auditing of care and outcomes; however, data are limited on children with chronic kidney disease (CKD) not on KRT. METHODS In March 2020, all UK Paediatric Nephrology centres submitted data on children aged <16 years with severely reduced kidney function as of December 2019, defined as an estimated glomerular filtration rate <30 mL/min/1.73 m2. RESULTS In total, 1031 children had severe CKD, the majority of whom (80.7%) were on KRT. The overall prevalence was 81.2 (95% CI 76.3 to 86.3) per million of the age-related population. CONCLUSIONS The prevalence of severe CKD among UK children is largely due to a high proportion of children on long-term KRT. Expanding data capture to include children with CKD before reaching failure will provide greater understanding of the CKD burden in childhood.
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Affiliation(s)
- Lucy Plumb
- UK Renal Registry, UK Kidney Association, Bristol, UK
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Winnie Magadi
- UK Renal Registry, UK Kidney Association, Bristol, UK
| | - Anna Casula
- UK Renal Registry, UK Kidney Association, Bristol, UK
| | - Ben C Reynolds
- Department of Paediatric Nephrology, Royal Hospital for Children Glasgow, Glasgow, UK
| | - Mairead Convery
- Department of Paediatric Nephrology, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Shuman Haq
- Department of Paediatric Nephrology, Southampton Children's Hospital, Southampton, UK
| | - Shivaram Hegde
- Department of Paediatric Nephrology, University Hospital of Wales, Cardiff, UK
| | - Andrew Lunn
- Department of Paediatric Nephrology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Michal Malina
- National Renal Complement Therapeutics Centre, Great North Children's Hospital, Newcastle Upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Henry Morgan
- Department of Paediatric Nephrology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Mordi Muorah
- Department of Paediatric Nephrology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Kay Tyerman
- Department of Paediatric Nephrology, Leeds Children's Hospital, Leeds, UK
| | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, London, UK
| | - Dean Wallace
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester, UK
| | - Carol Inward
- Department of Paediatric Nephrology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Stephen Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Dorothea Nitsch
- UK Renal Registry, UK Kidney Association, Bristol, UK
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - James Medcalf
- UK Renal Registry, UK Kidney Association, Bristol, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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Tse Y, Darlington ASE, Tyerman K, Wallace D, Pankhurst T, Chantziara S, Culliford D, Recio-Saucedo A, Nagra A. COVID-19: experiences of lockdown and support needs in children and young adults with kidney conditions. Pediatr Nephrol 2021; 36:2797-2810. [PMID: 33742247 PMCID: PMC7979448 DOI: 10.1007/s00467-021-05041-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/19/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND During the initial COVID-19 pandemic, young United Kingdom (UK) kidney patients underwent lockdown and those with increased vulnerabilities socially isolated or 'shielded' at home. The experiences, information needs, decision-making and support needs of children and young adult (CYA) patients or their parents during this period is not well known. METHODS A UK-wide online survey co-produced with patients was conducted in May 2020 amongst CYA aged 12-30, or parents of children aged < 18 years with any long-term kidney condition. Participants answered qualitative open text alongside quantitative closed questions. Thematic content analysis using a three-stage coding process was conducted. RESULTS One-hundred and eighteen CYA (median age 21) and 197 parents of children (median age 10) responded. Predominant concerns from CYA were heightened vigilance about viral (68%) and kidney symptoms (77%) and detrimental impact on education or work opportunities (70%). Parents feared the virus more than CYA (71% vs. 40%), and had concerns that their child would catch the virus from them (64%) and would have an adverse impact on other children at home (65%). CYA thematic analysis revealed strong belief of becoming seriously ill if they contracted COVID-19; lost educational opportunities, socialisation and career development; and frustration with the public for not following social distancing rules. Positive outcomes included improved family relationships and community cohesion. Only a minority (14-21% CYA and 20-31% parents, merged questions) desired more support. Subgroup analysis identified greater negative psychological impact in the shielded group. CONCLUSIONS This survey demonstrates substantial concern and need for accurate tailored advice for CYA based on individualised risks to improve shared decision making.
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Affiliation(s)
- Yincent Tse
- Great North Children's Hospital, Newcastle Upon Tyne, UK.
| | | | - Kay Tyerman
- Department of Paediatric Nephrology, Leeds Children’s Hospital, Leeds, UK
| | - Dean Wallace
- Department of Paediatric Nephrology, Royal Manchester Children’s Hospital, Manchester, UK
| | - Tanya Pankhurst
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - Sofia Chantziara
- School of Health Sciences, University of Southampton, Southampton, UK
| | - David Culliford
- NIHR Applied Research Collaboration Wessex, School of Health Sciences, University of Southampton, Southampton, UK
| | | | - Arvind Nagra
- Southampton Children’s Hospital, Southampton, UK
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3
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Garthwaite E, Reddy V, Douthwaite S, Lines S, Tyerman K, Eccles J. Clinical practice guideline management of blood borne viruses within the haemodialysis unit. BMC Nephrol 2019; 20:388. [PMID: 31656166 PMCID: PMC6816193 DOI: 10.1186/s12882-019-1529-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/21/2019] [Indexed: 12/11/2022] Open
Abstract
Some people who are receiving dialysis treatment have virus infection such as hepatitis B, hepatitis C and/or HIV that is present in their blood. These infections can be transmitted to other patients if blood is contaminated by the blood of another with a viral infection. Haemodialysis is performed by passing blood from a patient through a dialysis machine, and multiple patients receive dialysis within a dialysis unit. Therefore, there is a risk that these viruses may be transmitted around the dialysis session. This documents sets out recommendations for minimising this risk.There are sections describing how machines and equipment should be cleaned between patients. There are also recommendations for dialysing patients with hepatitis B away from patients who do not have hepatitis B. Patients should be immunised against hepatitis B, ideally before starting dialysis if this is possible. There are guidelines on how and when to do this, for checking whether immunisation is effective, and for administering booster doses of vaccine. Finally there is a section on the measures that should be taken if a patient receiving dialysis is identified as having a new infection of hepatitis B, hepatitis C or HIV.
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Affiliation(s)
| | - Veena Reddy
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Simon Lines
- Norwich and Norfolk University Hospitals NHS Foundation Trust, Norwich, UK
| | - Kay Tyerman
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - James Eccles
- Patient Representative, c/o The Renal Association, Bristol, UK
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4
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Ashby D, Borman N, Burton J, Corbett R, Davenport A, Farrington K, Flowers K, Fotheringham J, Andrea Fox RN, Franklin G, Gardiner C, Martin Gerrish RN, Greenwood S, Hothi D, Khares A, Koufaki P, Levy J, Lindley E, Macdonald J, Mafrici B, Mooney A, Tattersall J, Tyerman K, Villar E, Wilkie M. Renal Association Clinical Practice Guideline on Haemodialysis. BMC Nephrol 2019; 20:379. [PMID: 31623578 PMCID: PMC6798406 DOI: 10.1186/s12882-019-1527-3] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 12/15/2022] Open
Abstract
This guideline is written primarily for doctors and nurses working in dialysis units and related areas of medicine in the UK, and is an update of a previous version written in 2009. It aims to provide guidance on how to look after patients and how to run dialysis units, and provides standards which units should in general aim to achieve. We would not advise patients to interpret the guideline as a rulebook, but perhaps to answer the question: "what does good quality haemodialysis look like?"The guideline is split into sections: each begins with a few statements which are graded by strength (1 is a firm recommendation, 2 is more like a sensible suggestion), and the type of research available to back up the statement, ranging from A (good quality trials so we are pretty sure this is right) to D (more like the opinion of experts than known for sure). After the statements there is a short summary explaining why we think this, often including a discussion of some of the most helpful research. There is then a list of the most important medical articles so that you can read further if you want to - most of this is freely available online, at least in summary form.A few notes on the individual sections: 1. This section is about how much dialysis a patient should have. The effectiveness of dialysis varies between patients because of differences in body size and age etc., so different people need different amounts, and this section gives guidance on what defines "enough" dialysis and how to make sure each person is getting that. Quite a bit of this section is very technical, for example, the term "eKt/V" is often used: this is a calculation based on blood tests before and after dialysis, which measures the effectiveness of a single dialysis session in a particular patient. 2. This section deals with "non-standard" dialysis, which basically means anything other than 3 times per week. For example, a few people need 4 or more sessions per week to keep healthy, and some people are fine with only 2 sessions per week - this is usually people who are older, or those who have only just started dialysis. Special considerations for children and pregnant patients are also covered here. 3. This section deals with membranes (the type of "filter" used in the dialysis machine) and "HDF" (haemodiafiltration) which is a more complex kind of dialysis which some doctors think is better. Studies are still being done, but at the moment we think it's as good as but not better than regular dialysis. 4. This section deals with fluid removal during dialysis sessions: how to remove enough fluid without causing cramps and low blood pressure. Amongst other recommendations we advise close collaboration with patients over this. 5. This section deals with dialysate, which is the fluid used to "pull" toxins out of the blood (it is sometimes called the "bath"). The level of things like potassium in the dialysate is important, otherwise too much or too little may be removed. There is a section on dialysate buffer (bicarbonate) and also a section on phosphate, which occasionally needs to be added into the dialysate. 6. This section is about anticoagulation (blood thinning) which is needed to stop the circuit from clotting, but sometimes causes side effects. 7. This section is about certain safety aspects of dialysis, not seeking to replace well-established local protocols, but focussing on just a few where we thought some national-level guidance would be useful. 8. This section draws together a few aspects of dialysis which don't easily fit elsewhere, and which impact on how dialysis feels to patients, rather than the medical outcome, though of course these are linked. This is where home haemodialysis and exercise are covered. There is an appendix at the end which covers a few aspects in more detail, especially the mathematical ideas. Several aspects of dialysis are not included in this guideline since they are covered elsewhere, often because they are aspects which affect non-dialysis patients too. This includes: anaemia, calcium and bone health, high blood pressure, nutrition, infection control, vascular access, transplant planning, and when dialysis should be started.
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Affiliation(s)
- Damien Ashby
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, England.
| | - Natalie Borman
- Wessex Kidney Centre, Portsmouth NHS Trust, Portsmouth, England
| | - James Burton
- University Hospitals of Leicester NHS Trust, Leicester, England
| | - Richard Corbett
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, England
| | | | - Ken Farrington
- Lister Hospital, East & North Hertfordshire NHS Trust, Stevenage, England
| | - Katey Flowers
- Wessex Kidney Centre, Portsmouth NHS Trust, Portsmouth, England
| | | | - R N Andrea Fox
- School of Nursing and Midwifery, University of Sheffield, Sheffield, England
| | - Gail Franklin
- East & North Hertfordshire NHS Trust, Stevenage, England
| | | | | | - Sharlene Greenwood
- Renal and Exercise Rehabilitation, King's College Hospital, London, England
| | | | - Abdul Khares
- Haemodialysis Patient, c/o The Renal Association, Bristol, UK
| | - Pelagia Koufaki
- School of Health Sciences, Queen Margaret University, Edinburgh, Scotland
| | - Jeremy Levy
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, England
| | - Elizabeth Lindley
- Department of Renal Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, England
| | - Jamie Macdonald
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Bruno Mafrici
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | - Kay Tyerman
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Enric Villar
- Lister Hospital, East & North Hertfordshire NHS Trust, Stevenage, England
| | - Martin Wilkie
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
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5
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Dasgupta I, Keane D, Lindley E, Shaheen I, Tyerman K, Schaefer F, Wühl E, Müller MJ, Bosy-Westphal A, Fors H, Dahlgren J, Chamney P, Wabel P, Moissl U. Validating the use of bioimpedance spectroscopy for assessment of fluid status in children. Pediatr Nephrol 2018; 33:1601-1607. [PMID: 29869117 PMCID: PMC6061658 DOI: 10.1007/s00467-018-3971-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 03/31/2018] [Accepted: 04/27/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bioimpedance spectroscopy (BIS) with a whole-body model to distinguish excess fluid from major body tissue hydration can provide objective assessment of fluid status. BIS is integrated into the Body Composition Monitor (BCM) and is validated in adults, but not children. This study aimed to (1) assess agreement between BCM-measured total body water (TBW) and a gold standard technique in healthy children, (2) compare TBW_BCM with TBW from Urea Kinetic Modelling (UKM) in haemodialysis children and (3) investigate systematic deviation from zero in measured excess fluid in healthy children across paediatric age range. METHODS TBW_BCM and excess fluid was determined from standard wrist-to-ankle BCM measurement. TBW_D2O was determined from deuterium concentration decline in serial urine samples over 5 days in healthy children. UKM was used to measure body water in children receiving haemodialysis. Agreement between methods was analysed using paired t test and Bland-Altman method comparison. RESULTS In 61 healthy children (6-14 years, 32 male), mean TBW_BCM and TBW_D2O were 21.1 ± 5.6 and 20.5 ± 5.8 L respectively. There was good agreement between TBW_BCM and TBW_D2O (R2 = 0.97). In six haemodialysis children (4-13 years, 4 male), 45 concomitant measurements over 8 months showed good TBW_BCM and TBW_UKM agreement (mean difference - 0.4 L, 2SD = ± 3.0 L). In 634 healthy children (2-17 years, 300 male), BCM-measured overhydration was - 0.1 ± 0.7 L (10-90th percentile - 0.8 to + 0.6 L). There was no correlation between age and OH (p = 0.28). CONCLUSIONS These results suggest BCM can be used in children as young as 2 years to measure normally hydrated weight and assess fluid status.
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Affiliation(s)
| | - David Keane
- Departments of Renal Medicine and Medical Physics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Elizabeth Lindley
- Departments of Renal Medicine and Medical Physics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ihab Shaheen
- Department of Children's Nephrology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kay Tyerman
- Department of Children's Nephrology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Franz Schaefer
- Pediatric Nephrology Division, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Elke Wühl
- Pediatric Nephrology Division, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Manfred J Müller
- Institute for Human Nutrition and Food Science, Christian-Albrecht University, Kiel, Germany
| | | | - Hans Fors
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Paul Chamney
- Global R&D, Fresenius Medical Care, Bad Homburg, Germany
| | - Peter Wabel
- Global R&D, Fresenius Medical Care, Bad Homburg, Germany
| | - Ulrich Moissl
- Global R&D, Fresenius Medical Care, Bad Homburg, Germany
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6
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Brocklebank V, Johnson S, Sheerin TP, Marks SD, Gilbert RD, Tyerman K, Kinoshita M, Awan A, Kaur A, Webb N, Hegde S, Finlay E, Fitzpatrick M, Walsh PR, Wong EKS, Booth C, Kerecuk L, Salama AD, Almond M, Inward C, Goodship TH, Sheerin NS, Marchbank KJ, Kavanagh D. Factor H autoantibody is associated with atypical hemolytic uremic syndrome in children in the United Kingdom and Ireland. Kidney Int 2017; 92:1261-1271. [PMID: 28750931 PMCID: PMC5652378 DOI: 10.1016/j.kint.2017.04.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 03/31/2017] [Accepted: 04/28/2017] [Indexed: 01/23/2023]
Abstract
Factor H autoantibodies can impair complement regulation, resulting in atypical hemolytic uremic syndrome, predominantly in childhood. There are no trials investigating treatment, and clinical practice is only informed by retrospective cohort analysis. Here we examined 175 children presenting with atypical hemolytic uremic syndrome in the United Kingdom and Ireland for factor H autoantibodies that included 17 children with titers above the international standard. Of the 17, seven had a concomitant rare genetic variant in a gene encoding a complement pathway component or regulator. Two children received supportive treatment; both developed established renal failure. Plasma exchange was associated with a poor rate of renal recovery in seven of 11 treated. Six patients treated with eculizumab recovered renal function. Contrary to global practice, immunosuppressive therapy to prevent relapse in plasma exchange-treated patients was not adopted due to concerns over treatment-associated complications. Without immunosuppression, the relapse rate was high (five of seven). However, reintroduction of treatment resulted in recovery of renal function. All patients treated with eculizumab achieved sustained remission. Five patients received renal transplants without specific factor H autoantibody-targeted treatment with recurrence in one who also had a functionally significant CFI mutation. Thus, our current practice is to initiate eculizumab therapy for treatment of factor H autoantibody-mediated atypical hemolytic uremic syndrome rather than plasma exchange with or without immunosuppression. Based on this retrospective analysis we see no suggestion of inferior treatment, albeit the strength of our conclusions is limited by the small sample size.
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Affiliation(s)
- Vicky Brocklebank
- National Renal Complement Therapeutics Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Sally Johnson
- Great North Children's Hospital, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle, UK
| | - Thomas P Sheerin
- National Renal Complement Therapeutics Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen D Marks
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rodney D Gilbert
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kay Tyerman
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Meredith Kinoshita
- The Department for Paediatric Nephrology & Transplantation, The Children's University Hospital, Dublin, Ireland
| | - Atif Awan
- The Department for Paediatric Nephrology & Transplantation, The Children's University Hospital, Dublin, Ireland
| | - Amrit Kaur
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Nicholas Webb
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Eric Finlay
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Patrick R Walsh
- National Renal Complement Therapeutics Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Edwin K S Wong
- National Renal Complement Therapeutics Centre, Newcastle University, Newcastle upon Tyne, UK
| | | | - Larissa Kerecuk
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Alan D Salama
- UCL Centre for Nephrology, Royal Free London NHS Foundation Trust, Rowland Hill Street, London, UK
| | - Mike Almond
- Southend University Hospital, Prittlewell Chase, Westcliff-on-Sea, UK
| | - Carol Inward
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, UK
| | - Timothy H Goodship
- National Renal Complement Therapeutics Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Neil S Sheerin
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Kevin J Marchbank
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - David Kavanagh
- National Renal Complement Therapeutics Centre, Newcastle University, Newcastle upon Tyne, UK.
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7
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Gupta A, Campion-Smith J, Hayes W, Deal JE, Gilbert RD, Inward C, Judd BA, Krishnan RG, Marks SD, O'Brien C, Shenoy M, Sinha MD, Tse Y, Tyerman K, Mallik M, Hussain F. Positive trends in paediatric renal biopsy service provision in the UK: a national survey and re-audit of paediatric renal biopsy practice. Pediatr Nephrol 2016; 31:613-21. [PMID: 26525201 DOI: 10.1007/s00467-015-3247-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 09/15/2015] [Accepted: 10/04/2015] [Indexed: 01/19/2023]
Abstract
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.
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Affiliation(s)
- Asheeta Gupta
- Birmingham Childrens Hospital, Steelhouse Lane, Birmingham, UK, B4 6NH.
| | | | - Wesley Hayes
- Bristol Royal Hospital for Children, Bristol, UK
| | | | | | | | - Brian A Judd
- Alder Hey Children's Hospital in Liverpool, Liverpool, UK
| | | | | | - Catherine O'Brien
- Birmingham Childrens Hospital, Steelhouse Lane, Birmingham, UK, B4 6NH
| | - Mohan Shenoy
- Royal Manchester Children's Hospital, Manchester, UK
| | | | - Yincent Tse
- Great North Children's Hospital, Newcastle Upon Tyne, UK
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8
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Bonthuis M, van Stralen KJ, Jager KJ, Baiko S, Jahnukainen T, Laube GF, Podracka L, Seeman T, Tyerman K, Ulinski T, Groothoff JW, Schaefer F, Verrina E. Dyslipidaemia in children on renal replacement therapy. Nephrol Dial Transplant 2013; 29:594-603. [DOI: 10.1093/ndt/gft429] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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9
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Amin N, Alvi NS, Barth JH, Field HP, Finlay E, Tyerman K, Frazer S, Savill G, Wright NP, Makaya T, Mushtaq T. Pseudohypoaldosteronism type 1: clinical features and management in infancy. Endocrinol Diabetes Metab Case Rep 2013; 2013:130010. [PMID: 24616761 PMCID: PMC3922296 DOI: 10.1530/edm-13-0010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 07/10/2013] [Indexed: 11/11/2022] Open
Abstract
Type 1 pseudohypoaldosteronism (PHA) is a rare heterogeneous group of disorders characterised by resistance to aldosterone action. There is resultant salt wasting in the neonatal period, with hyperkalaemia and metabolic acidosis. Only after results confirm isolated resistance to aldosterone can the diagnosis of type 1 PHA be confidently made. Type 1 PHA can be further classified into i) renal type 1 (autosomal dominant (AD)) and ii) multiple target organ defect/systemic type 1 (autosomal recessive (AR)). The aim of this case series was to characterise the mode of presentation, management and short-term clinical outcomes of patients with PHA type 1. Case notes of newly diagnosed infants presenting with PHA type 1 were reviewed over a 5-year time period. Seven patients were diagnosed with PHA type 1. Initial presentation ranged from 4 to 28 days of age. Six had weight loss as a presenting feature. All subjects had hyperkalaemia, hyponatraemia, with elevated renin and aldosterone levels. Five patients have renal PHA type 1 and two patients have systemic PHA type, of whom one has had genetic testing to confirm the AR gene mutation on the SCNN1A gene. Renal PHA type 1 responds well to salt supplementation, whereas management of patients with systemic PHA type 1 proves more difficult as they are likely to get frequent episodes of electrolyte imbalance requiring urgent correction.
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Affiliation(s)
- N Amin
- Paediatric Endocrinology Leeds Teaching Hospitals Leeds General Infirmary, Leeds UK
| | - N S Alvi
- Paediatric Endocrinology Leeds Teaching Hospitals Leeds General Infirmary, Leeds UK
| | - J H Barth
- Clinical Chemistry Leeds Teaching Hospitals Leeds UK
| | - H P Field
- Clinical Chemistry Leeds Teaching Hospitals Leeds UK
| | - E Finlay
- Paediatric Nephrology Leeds Teaching Hospitals Leeds UK
| | - K Tyerman
- Paediatric Nephrology Leeds Teaching Hospitals Leeds UK
| | - S Frazer
- Paediatric Medicine Bradford Teaching Hospitals Bradford UK
| | - G Savill
- Paediatric Medicine Airedale General Hospital Keighley UK
| | - N P Wright
- Paediatric Endocrinology Sheffield Children's Hospital Sheffield UK
| | - T Makaya
- Paediatric Endocrinology Sheffield Children's Hospital Sheffield UK
| | - T Mushtaq
- Paediatric Endocrinology Leeds Teaching Hospitals Leeds General Infirmary, Leeds UK
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10
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Shaheen IS, Fitzpatrick M, Brownlee K, Bhuskute N, Elliott M, Powis M, Ahmad N, Tyerman K. Bilateral progressive cystic nephroma in a 9-month-old male infant requiring renal replacement therapy. Pediatr Nephrol 2010; 25:1755-8. [PMID: 20414683 DOI: 10.1007/s00467-010-1528-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 02/25/2010] [Accepted: 02/26/2010] [Indexed: 01/01/2023]
Abstract
We report the case of a 3-year-old boy who presented at 9 months of age with abdominal distension and was found to have a triad of bilateral cystic nephroma, pleuropulmonary blastoma (PPB) and juvenile intestinal polyps. There have been three previous reported cases of patients with the same associated diagnoses. Our patient is the first reported patient with PPB who received renal replacement therapy and progressed to successful renal transplantation. The potential increased risk of progression of malignancy of PPB (type 1) with immunosuppression following transplantation remains unknown.
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Affiliation(s)
- Ihab Sakr Shaheen
- Department of Paediatric Nephrology, St. James's University Hospital, Leeds LS9 7TF, UK.
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11
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Phillips RS, Tyerman K, Al-Kassim MI, Picton S. A systematic review of the accuracy and utility of early markers of Ifosfamide-induced proximal tubulopathy in survivors of childhood cancers. Pediatr Hematol Oncol 2008; 25:107-13. [PMID: 18363176 DOI: 10.1080/08880010701885276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study was conducted to identify and assess the accuracy and utility of any early markers of clinically significant proximal tubulopathy in children treated with ifosfamide chemotherapy. Ifosfamide is widely used either as a solitary agent or in conjunction with various other chemotherapeutic agents in treating solid tumors of childhood. It is highly effective but can cause short-term and long-term damage to kidneys, most commonly resulting in a tubular nephropathy and/or glomerular dysfunction. This may lead to chronic renal failure and metabolic bone disease in long-term survivors of childhood cancer. Multiple electronic databases (Cochrane, MEDLINE, EMBASE) were searched for primary studies describing the predictive value of early blood or urine tests to predict proximal tubulopathy. Citation searching (using reference lists and Science Citation Index searches) was also undertaken. Analysis was undertaken using criteria suggested by the MOOSE (Meta-analysis of Observational Studies in Epidemiology) collaboration. Studies were reviewed by at least 2 authors and disagreements resolved by consensus. Initial searches revealed approximately 310 studies of which 38 papers were selected for full analysis. Only 4 papers described the predictive value of early markers proximal tubular nephropathy. The remaining studies estimated prevalence of acute or chronic nephropathy without presenting predictive data. Of the 4 papers selected for analysis, 2 papers assessed the value of beta-2 microglobulinuria, and 3 addressed quantitative aminoaciduria. Test characteristics ranged from sensitivities of 82 to 100% and specificities of 84 to 100%, although the confidence intervals around these estimates were wide. Given the paucity of data, to consider further the use of early markers of proximal tubular nephropathy a prospective evaluation of patients who have been treated with ifosfamide based regimes should be undertaken.
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Affiliation(s)
- Robert S Phillips
- Regional Department of Paediatric Haematology/Oncology, St James's Hospital, Leeds, UK.
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12
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Fan X, Tyerman K, Ang A, Koo K, Parameswaran K, Tao K, Mai L, Lang H, West LJ. A novel tool for B-cell tolerance research: characterization of mouse alloantibody development using a simple and reliable cellular ELISA technique. Transplant Proc 2005; 37:29-31. [PMID: 15808536 DOI: 10.1016/j.transproceed.2004.12.119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In animal-based transplantation research, the measurement of anti-donor antibodies in transplant recipients is limited by lack of an appropriate technique. We have developed a novel immunoassay capable of quantifying antibody bound to cell-surface major histo- compatability complex (MHC) and non-MHC antigens, using splenocytes from wild-type and MHC-deficient mice as antigen-bearing target cells. We utilized our "cellular ELISA" (CELISA) technique to study the development of tolerance versus immunity in the B-cell compartment in response to neonatal exposure to allogeneic fetal liver cells (FLC). This neonatal tolerance protocol typically induces permanent acceptance of donor-type and third-party cardiac allografts, but rejection of both donor-type and third-party skin grafts occurs. C3H/He (C3H; H-2(k)) mice were injected as neonates with BALB/c (BALB; H-2(d)) FLC and transplanted as adults with C57BL/6 (B6; H-2(b)) cardiac grafts. Despite long-term acceptance of third-party B6 cardiac grafts, serum contained increased anti-B6 IgG and IgM levels as measured by CELISA; IgM production was elevated by 2 weeks posttransplant and remained stable, while IgG production increased rapidly between 2 and 5 weeks posttransplant. In another experimental setting, CELISA assays were able to detect that neonatal injection of C3H mice with FLC from wild-type B6 mice or from MHC class II-deficient or class I/II-deficient (B6 background) mice (CI(+)CII(+), CI(+)CII(-), CI(-)CII(-), respectively) prevented sensitization to B6 antigens by subsequent skin transplants but did not induce graft acceptance, whereas FLC from MHC class I-deficient-only (CI(-)CII(+)) did not prevent B6 sensitization. The CELISA technique is a simple and sensitive means for quantifying alloantibodies in mice and will assist in further delineating the role of the B-cell compartment in neonatally induced cardiac allograft acceptance.
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Affiliation(s)
- X Fan
- Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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13
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Affiliation(s)
- Bob Phillips
- Paediatric Intensive Care Unit, St James's Hospital, Leeds LS9 7TF.
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14
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Parameswaran K, Tao K, Mai L, Tyerman K, Fan X, West L. The role of alloantibody in neonatally-induced cardiac allograft acceptance. J Heart Lung Transplant 2005. [DOI: 10.1016/j.healun.2004.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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15
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Tyerman K. Libraries' textbook approach to total quality. Int J Health Care Qual Assur 1993; 7:10-1. [PMID: 10136785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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16
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Tyerman K, Barron PT, Da Costa M, McCleish M, Fulford A, Collier SJ, Thiru S. Prolongation of rat cardiac allograft survival by pretreatment of the donor to reduce class II antigen expression and dendritic cell content. Transplant Proc 1990; 22:2325. [PMID: 2219389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- K Tyerman
- Department of Pathology, Cambridge University, UK
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17
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Barron PT, Tyerman K, McLeish M, Thiru S, Collier SJ. Effect of modulation of donor class II antigen expression on the survival of rat cardiac allografts. Transplant Proc 1990; 22:1931-2. [PMID: 2117818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- P T Barron
- Department of Surgery, University of Cambridge, Addenbrookes Hospital, England
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