Nephrology

The Department of Paediatric Nephrology

Alder Hey Children’s Hospital

Nephrology Clinical Service

The Department of Nephrology provides inpatient, day care and outpatient services for children and young adults with kidney disease. The services provided include medical treatment, dialysis, and follow-up of kidney transplant patients. Given that most kidney conditions are chronic, children will be known to the service for a long time. This important issue influences the way services are delivered. The department works closely with other hospital departments to provide care to children with complex multisystem conditions.

Referrals are accepted from General Practitioners and Pediatricians throughout the region and North Wales. Patients are referred for various different reasons such as:

Acute kidney injury; a sudden loss, usually temporary, of kidney function
Chronic kidney disease; long term reduced kidney function, often a high blood creatinine level
Haematuria (blood loss in the urine)
Kidney stones
Chronic or recurrent urinary tract infections
Proteinuria and nephrotic syndrome (protein loss in urine)
High blood pressure
Glomerulonephritis (kidney inflammation)
Cystic kidney disease and other kidney malformations
Abnormalities of body fluids, electrolytes and acid levels

The Alder Hey Department of Nephrology was among the first in the UK to offer dialysis to children with kidney failure (haemodialysis from 1968 and peritoneal dialysis from 1973/74). The kidney transplant service commenced in 1977/78. Since the early 1990’s, Alder Hey has collaborated with Royal Manchester Children’s Hospital and Manchester Royal Infirmary in a supra-regional paediatric kidney transplant programme.

Acute and chronic renal replacement therapy is provided. For long term patients both in-center haemodialysis and home peritoneal dialysis are fully supported. Preparation for, and follow up of kidney transplant recipients is undertaken. The department also provides plasma exchange therapy and support for premature infants with kidney problems at Liverpool Women’s Hospital.

Future anticipated developments include:

A New Dialysis unit within the Children’s Health Park. This will provide greater space and privacy for patients.
Increased involvement of other specialties the care pathway i.e. Professions Allied to Medicine in an extended role.
Managing increasingly complex patients with End Stage Kidney Failure for transplantation and chronic dialysis.
Increasing near patient testing – biochemistry.
Increasing technology of dialysis modalities – haemodialfiltration, daily & nocturnal haemodialysis.

Audit & Research
The department has an ongoing programme of internal audit to monitor clinical activity according to national guidelines. The department also participates in external audit through the British Association for Paediatric Nephrology (kidney biopsy outcomes, management of post-transplant hypertension) and the UK Renal Registry (end-stage kidney disease, dialysis and kidney transplantation).

The department has a Research Fellow who is undertaking laboratory and clinical research, jointly with the Department of Rheumatolgy, into the kidney inflamation associated with systemic lupus erythematosis. The consultants have been involved in research in the fields of: fluid & electrolyte physiology; urinary tract infection; calcium metabolism & nephrocalcinosis; micro-albuminuria in childhood-onset diabetes mellitus; kidney function after cardiac surgery; steroid-sensitive nephrotic syndrome; anaemia management in chronic kidney disease. The unit has taken part in multi-centre studies of varicella vaccination for chronic kidney failure patients and also immunosuppressive treatments for nephrotic syndrome and paediatric kidney transplantation

Transition Service
Patients with long-term kidney problems generally transfer to adult services at 16 – 18 years of age, depending upon individual needs. Young people are identified as early as 14 years to begin adjusting the way their care is delivered to prepare them for adult services. The department has links with several adult nephrology units to facilitate transfer for continuing care.

Team Work

As well as medical staff, the multi-disciplinary team is comprised of ward nurses, specialist dialysis nurses, advanced nurse practitioners, specialist dieticians, a pharmacist, clinical psychologist and hospital play therapists. The team works closely with surgical colleagues in the Department of Urology to provide integrated treatment for patients with complex urinary tract abnormalities. Support for children who develop kidney problems when under the care of other teams, particularly the intensive care unit, cardiology, rheumatology and oncology, is provided.

Team Members

Consultants: Dr. Brian A Judd

Dr. Caroline A Jones

Dr. Richard Holt

Dr. Henry Morgan

Advanced Nurse Practitioner Allison Birch

Associate Nurse Specialist Tracy Daglar

Dieticians Alison Holmes

Marianne Croft

Psychologist Clare Chamberlain-Parr

Play Specialists Jackie Glover (ward D2)

Elaine Richardson (ward C3)