Feature: Specialized Kidney Disease Clinic

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| 21 March 2024

The Specialized Kidney Disease Clinic at Kingston Health Sciences Centre is the kidney clinic where arguably some of the sickest kidney patients, with the most acute and severe kidney disease presentations, are assessed and followed. In 2018, this clinic became one of six specialty clinics for Glomerulonephritis (GN) and pregnancy in chronic kidney disease in the province of Ontario.

Patients followed at this clinic require close observation and follow-up as the medications used to treat the various diseases can be quite toxic and have a number of side effects. The Specialized Kidney Disease Clinic was expanded in terms of its scope in 2019 to include a Rheumatology/Nephrology combined clinic, run by Dr. Marie Clements-Baker and Dr. Jocelyn Garland. What this means is that if patients have an active autoimmune kidney disease as part of a general autoimmune condition such as systemic lupus or ANCA vasculitis, they are seen together by dual Nephrology/Rheumatology expertise in this clinic.

From a Rheumatology point of view, Dr. Clements-Baker assesses patients for manifestations of autoimmune disease activity that may be affecting oral, ENT, skin, GI, and joints that suggest disease is active and may help direct choice or addition of therapy.

Dr. Garland specializes in the interpretation of kidney biopsy pathology reports for such patients, aims to prevent progression of the autoimmune kidney disease to requiring dialysis, and aids in the implementation of the patient’s treatment plan.

This is a very important clinic for these patients. Patients who have autoimmune disease and vasculitis can be very sick and are at risk for progressing to requiring dialysis. Both Dr. Clements-Baker and Dr. Garland have developed a skill set in the diagnosis and management of these rare diseases and thus a high standard of care is maintained, applying the latest evidence in the implementation of the therapeutic approach.

Dr. Clements-Baker and Dr. Garland have established clinical collaborations with national and international colleagues who practice and research in these subspecialized areas and are able to access international colleagues for case discussion to improve the outcomes for their patients. They both attend multiple conferences and educational events on an annual basis to ensure they are current in the clinical assessment and treatment of patients and are also both members of the Canadian Vasculitis group, which is a group of well-known Canadian clinicians and researchers who specialize in the therapy of the vasculitides.

One advantage of this dual-specialist multi-disciplinary clinic is that the patient benefits from “one-stop shopping.” During the patient encounter, they can discuss concerns about the progress of the patient’s condition and make real-time decisions about whether therapy changes are required. Otherwise, complex multi-disease patients often wait until the various sub-specialists have assessed their respective clinical issues and this approach can delay decisions for treatment. Maintaining a high-level subspecialty focus with consistent evidence-based practice that provides the best possible care to their patients with rare disease is the top priority.

Their future goals are to continue to maintain the best possible care and collegial multi-disciplinary approach for their patients. As CanVasc members, they will soon join the national longitudinal vasculitis study with CanVasc with the goal of collecting data and contributing to the heightened understanding of these complex patients.

They are also looking forward to proposing a vasculitis fellowship for both Rheumatology and Nephrology streams in the near future.

This story was originally published in the 2022 Department of Medicine Annual Report. Since then, we are thrilled to have welcomed Dr. Lagu Androga to the team in July 2023. Dr. Androga’s clinical and research interests are in glomerulonephritis and health care delivery. He has published articles in the areas of telenephrology and glomerulonephritis.

Feature: Specialized Kidney Disease Clinic

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Feature: Specialized Kidney Disease Clinic

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