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Glomerulonephritis

The GN network & registry aims to improve our understanding and treatment of glomerulonephritis.

Glomerulonephritis (GN) is a group of kidney diseases that, while relatively rare, represent the second most common cause of end-stage renal disease in Canada. 

Network

These diseases appear to be increasing in prevalence, and disproportionately affect younger Canadians. GN patients experience substantial comorbidity over time and incur high costs to the health system.

As part of its overall mandate to manage and improve care for kidney patients across the province, the BC Renal Agency is developing a GN network with the goals of improving both our understanding of GN and treatment for this subset of kidney patients.

The first of its kind in Canada, the GN network will include: 

  • integration of a GN pathology database with the PROMIS information system
  • care protocols and guidelines
  • assessment of best-practice care models.
 

Clinicians across BC have a key role to play in both the collection of standardized data and ongoing care of GN patients. To support clinicians, the network has:


  • made several options available to simplify the data collection process and ensure it can easily be integrated into each physician's clinical workflow
  • developed a number of clinical tools, including flowsheets, provincial rounds and a referral clinic, to support ongoing GN patient care
  • created a GN formulary to ensure patients have access to life or organ saving immunosuppressant medications. 
 
Collection of a standardized set of data in a GN Registry is necessary to better describe the care, outcomes and health utilization of GN patients. This data will be stored in PROMIS and is similar to that captured for all renal patients (e.g. CKD, transplant), including demographics, medications, blood pressure, height, weight and comorbidities.

Registration in the BC GN Registry will entitle patients to coverage for CKD medications (such as vitamin D analogues, calcium, iron and ESAs) as well as coverage for immunosuppressive agents listed in the GN formulary.

Aggregate, anonymized data will be available to all nephrologists in the province for personal practice assessment use. As the data steward, the BC Renal Agency will ensure best practices and patient privacy.
 

GN clinic

To receive a second opinion on a GN patient, physicians can refer to the BC GN Clinic in Vancouver using the form and fax number below.

The GN clinic offers a TeleHealth option to facilitate consults with patients who cannot travel to Vancouver.

BC GN Clinic
Sean Barbour
Medical Lead, GN Registry
Fax: 604-875-5952 Phone: 604-875-5950

Protocols & tools

Protocols

Evidenced-based treatment protocols have been demonstrated to improve the quality of healthcare delivered to patients.

Below are two types of resources for GN, 1) disease-specific protocols designed to guide treatment based on the latest evidence and 2) drug-specific pre-printed orders designed to be implemented in each health authority to facilitate physician prescribing of complex therapies. The intention is for both types of resources to be complementary.

About these protocols

The intention is for the protocols for IgA nephropathy and infusion to be complementary.


New protocols will be added intermittently, with the goal of developing a treatment protocol for each type of commonly encountered GN. Nephrologists will be alerted when new protocols are available.



 Clinical tools
To support the care of patients with glomerulonephritis, the BC GN Network has developed the following clinical tools:

Biopsy
Flow sheet of laboratory results & immunosuppression history

A laboratory flow sheet designed specifically for patients with GN is available within PROMIS. It contains blood pressure, weight, immunosuppression medications with drug levels, a current medication list and laboratory results specific to GN. The instructions to follow are below.

Once logged into PROMIS:

  1. Under "Reports" select "GN Flowsheet"
  2. The default lab list is "GN Flowsheet", which is a generic GN-related lab list. Alternatively, you can select any other available lab list.
  3. Click "Run Report".

Presentations on topics specific to GN patients will be broadcast to all nephrology groups in the province, and will occur approximately every 4 months. Notifications will be sent by email with details on the topics, dates and times. See Education & Development for the video archive. 

 

Participate in the GN Clinical Trials: FSGS and PEXIVAS 

 

Formulary

The first of its kind, the Glomerulonephritis Formulary, launched on April 15, 2014, funds immunosuppressant medications for patients with glomerulonephritis registered with the BC Renal Agency.

The objective of this formulary is to improve and ensure equitable evidence-based use of life or organ saving medications for patients with glomerulonephritis.

Nephrologists who would like to prescribe an immunosuppressant medication listed on the Glomerulonephritis Formulary are asked to:
  • register the patient in PROMIS
  • submit the appropriate application form along with a prescription to Macdonald's Prescriptions. 

The use of these drugs will be closely monitored and the funding policy will be re-evaluated periodically.


Funding for rituximab (Rituxan®) will be provided on a restricted basis to individuals with glomerulonephritis who fail conventional therapy or who meet exceptional criteria as described by their nephrologist. In almost all circumstances, rituximab should be considered as a treatment of last resort.

Nephrologists who would like to put a patient on rituximab (Rituxan®) are asked to 
  • ensure the patient is registered in PROMIS
  • submit the application form to the BC Renal Agency.

An adjudication team consisting of two members of the Pharmacy & Formulary Review Committee will review each request, with approval given on a case-by-case basis. Due to costs, the use of this drug will be closely monitored. The funding policy will be re-evaluated periodically.


 

Importance of data to measure outcomes & support evidence-based practice

Our collective goal is to improve patient outcomes while being financially accountable for all formulary medications. Data capture on the application forms and through PROMIS is therefore critical, as it is in all other aspects of BC Renal Agency programs. 

We will be conducting real-time evaluation of the use of these medications and the funding policy will be re-evaluated periodically.

What to do with patients currently on immunosuppression for glomerulonephritis

Patients currently on immune therapy through a PharmaCare Special Authority or extended health care authorization can continue to access the medication through these programs until the period of coverage is complete, and then switch to the BC Renal Agency formulary.

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