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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 Network 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
  • dedicated GN formulary, ensuring access to funded immunosuppression medications
  • 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, BC Renal will ensure best practices and patient privacy.
 

GN Registry Patient Summary Sheet + Form

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.
  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.

 

 

 

 
 

 

These are drug-specific pre-printed orders designed to be implemented in each health authority to facilitate physician prescribing of complex therapies.

 

 

This document provides glucocorticoid-induced osteoporosis prevention recommendations and summarizes the evidence that supports it. Where relevant, its contents have been embedded into the BC Renal GN treatment protocols.


About these protocols

These protocols are developed by the BC Renal GN Committee to help guide treatment based on the latest evidence. 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 Network.

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 oral 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.


 

The following Medication Information Sheets have been created by BC Renal to provide patients with customized information when these medications are used to treat glomerulonephritis:


 
Funding for rituximab 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 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.


6 out of 10 rituximab applications the BC Renal receives for ANCA vasculitis cases are for patients who have previously received a high cumulative dose of cyclophosphamide (which is considered first-line therapy), have a prior history of malignancy, or have a concern with regards to infertility risk with the use of cyclophosphamide. To help clinicians make evidence informed decisions for these patients, we systematically reviewed the published literature to quantify the risk of malignancy and infertility with cyclophosphamide therapy. A high level summary as well as a detailed report can be found below.

Starting October 30, 2020, all patients receiving reimbursement for rituximab by BC Renal will be provided a biosimilar rituximab called (RiximyoTM). This includes patients newly starting on therapy, patients who have received the originator rituximab (RituxanÒ) previously but are not in the middle of a treatment cycle, and patients currently receiving maintenance therapy with the originator rituximab (RituxanÒ). More information can be found in the following document:


 

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 Network 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 Network formulary.

 

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SOURCE: Glomerulonephritis ( )
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