Related Experiment Video
Updated: May 7, 2025
5/6th Nephrectomy in Combination with High Salt Diet and Nitric Oxide Synthase Inhibition to Induce Chronic Kidney Disease in the Lewis Rat
Published on: July 3, 2013
Outcomes Using a Standardized Provincial Childhood Nephrotic Syndrome Clinical Pathway
Laura H Kim1, Marisa Catapang1, Nonnie Polderman1
1Division of Nephrology, BC Children's Hospital, Vancouver, Canada.
Insights
The British Columbia Childhood Nephrotic Syndrome Clinical Pathway ensures consistent care for children with nephrotic syndrome across different clinics. Outcomes and treatment are comparable between the main hospital and regional centers.
Area of Science:
- Pediatric Nephrology
- Clinical Pathway Implementation
- Healthcare Standardization
Background:
- The British Columbia (BC) Childhood Nephrotic Syndrome Clinical Pathway (CNSCP) was established in 2013 to standardize care for pediatric nephrotic syndrome (NS).
- Children in BC receive nephrology care at BC Children's Hospital (BCCH) and various regional clinics.
Purpose of the Study:
- To compare induction therapy and clinical outcomes for children with NS treated at BCCH versus regional clinics post-CNSCP implementation.
- To assess practice variations in pediatric nephrotic syndrome care within British Columbia.
Main Methods:
- A retrospective cohort study included children aged 1-17 with new-onset NS from 2013-2019, with at least 12 months follow-up.
- Exclusion criteria included non-minimal change disease, steroid resistance, incomplete induction, or <6 months pathway treatment in the first year.
- Clinics were categorized as BCCH or regional (Surrey, Prince George, Kelowna).
Main Results:
- No significant differences were observed in induction prednisone exposure, annualized relapse rate, or frequently relapsing courses between BCCH and regional clinics.
- Similar numbers of first-year clinic visits and dietitian-reviewed food records were noted.
- A higher proportion of children at BCCH received recommended ophthalmology surveillance (87% vs. 59%).
Conclusions:
- The CNSCP has led to comparable care and similar outcomes for children with NS at BCCH and regional clinics.
- The study indicates minimal practice variation in nephrotic syndrome management across BC since pathway implementation.
- Ophthalmology surveillance may require further attention in regional settings.
Background:
In 2013, the British Columbia (BC) Childhood Nephrotic Syndrome Clinical Pathway (CNSCP) was developed to standardize the care of children with nephrotic syndrome (NS). In BC, children access nephrology care at BC Children's Hospital (BCCH) and multiple regional clinics.
Objective:
The primary objective was to compare induction therapy and clinical outcomes between BCCH and regional clinics since implementation of the CNSCP.
Design Setting And Patients:
This was a retrospective cohort study of children with NS in BC.
Measurements And Methods:
We conducted a retrospective cohort study of children 1 to 17 years old with new-onset NS from 2013 to 2019 inclusive with minimum 12 months of follow-up. Children with non-minimal change disease, steroid resistance, incomplete induction therapy, or less than 6 months of pathway treatment within their first year post-diagnosis were excluded. Clinics were categorized as BCCH or regional (Surrey, Prince George, or Kelowna).
Results:
Sixty-nine patients were included, with 52 (75%) at BCCH and 17 (25%) at regional clinics. There were no significant between-group differences in age, sex, or clinical characteristics at time of diagnosis. Comparing BCCH and regional clinics, there was no difference in induction prednisone exposure (median 3400, interquartile range [IQR] 3331-3585 mg/m2 vs 3492, IQR 3397-3644 mg/m2, P = .167), annualized relapse rate (median 3.3, IQR 1.1-5.3 vs 2.3, IQR 0.5-4.2, P = .575), or development of frequently relapsing courses (50% vs 62%, P = .475). There was a similar number of first-year clinic visits (4.2 ± 1.2 vs 4.0 ± 1.8, P = .655) and dietitian-reviewed food records (67% vs 47%, P = .135, BCCH vs regional). More children at BCCH had a recommended ophthalmology surveillance visit (87% vs 59%, P = .01, BCCH vs regional).
Limitations:
Study limitations include small sample size and exclusion of children with complicated NS (ie, relapse during induction, steroid resistance).
Conclusion:
Since we implemented the CNSCP, children with NS received comparable care and had similar outcomes at BCCH and regional clinics without significant practice variation.
Related Concept Videos
01:11Guidelines for Writing Outcome
Patient outcomes reflect the patient's response to the goal rather than what the nurse aims to achieve. Terminology should be observable and measurable to avoid the reader's interpretation. The desired outcome should be realistic and achievable in the designated care timeframe. Expected outcomes should align with adjunctive therapies. The outcome should enhance care...
01:10Nephrons
01:27Nursing Clinical Information System
A Nursing Clinical Information System (NCIS) is a specialized type of healthcare information system tailored to meet the unique needs of nursing practice. It incorporates the principles of nursing informatics to streamline information management and improve the quality of care delivery.
Critical attributes of NCIS include:
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:29Chronic Pancreatitis II: Collaborative Care
Assessment:
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...