Children with Banff II rejection, an inflammatory response and early graft loss are more likely to require transplant nephrectomy. Nephrectomy may be associated with higher circulating HLA antibody levels.

MRCPCH part 1B outcome was related to place of primary medical qualification, with a significantly lower pass rate for international medical graduates compared with UK graduates, as well as significant variation in examination outcome between graduates from different UK medical schools. These data may be used to guide new initiatives to improve support and education for these trainees and to inform development of undergraduate curricula and help trainees prepare more successfully for postgraduate examinations.

Mid aortic syndrome (MAS) is a rare condition often presenting with severe hypertension. It is characterized by narrowing of the abdominal aorta. We here describe a case of complete occlusion of the abdominal aorta presenting in infancy. This child presented at four months of age with heart failure and hypertension. CT angiogram showed total narrowing of the abdominal aorta. This was initially felt to be too severe for surgical treatment and he was planned for palliative care. We were however able to improve his blood pressure with antihypertensive agents and he underwent succesful angioplasty at five and a half months of age. He has required three further angioplasty procedures and still needs two antihypertensive agents to control his blood pressure. His renal function remains normal and at age six years he has excellent quality of life with normal growth and development. This case illustrates that the combination of medical treatment and angioplasty can give an excellent long-term treatment response even in children with extremely severe MAS. This boy now has normal blood pressure and has experienced normal growth, development and quality of life.

Background and aims A significant bulk of the registrar's workload is spent dealing with telephone calls from parents, young people, community teams and paediatricians working at DGHs. In our paediatric nephrology department we wanted to improve the management of such calls. The current practice was suffering from poor continuity of documentation, especially in cases where multiple calls about a single child had taken place, and poor handover within our internal team. We undertook a trainee-led service improvement project to review the process. Methods We formally audited our current practice over a 2 week period to assess the volume, type and frequency of calls and review the documentation of new and frequent telephone consultations on the same child. Following the audit we worked with the medical team and clerical staff to create a proforma for collecting clinical data and a filing system to improve continuity of documentation between registrar shifts. The proforma and filing system were then introduced for a 6-week trial period and the process of managing outside calls was re-audited by the same registrar team. Results Our starting audit of telephone consultations showed that the majority of calls (70%) were from paediatric teams at other hospitals and over the 2 week period multiple calls were registered on the same patients. Overall documentation was poor, limited and in many instances (60% of follow-up calls) previous clinical information and advice given was not available for subsequent calls. After introducing the new proforma we re-audited external calls and found clearer documentation and significantly reduced instances (<5%) where previous telephone consultation notes were unavailable. Conclusions We describe a simple trainee-led service improvement project that produced a positive result to the way telephone calls were managed in our centre. This improved the quality of care provided to patients whose care we share with other hospitals. We also achieved an improvement to the service provided to our colleagues working at other centres, improving efficiency by reducing the need to repeat clinical information. Finally, the new system actually improved time management for our internal team owing to improved documentation allowing more simple and effective handover of clinical information.