How a 'Glomerulonephritis Board' Can Help Improve Patient Care

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Glomerular basement membrane "spikes" in a patient with membranous glomerulonephritis.
Glomerular basement membrane "spikes" in a patient with membranous glomerulonephritis.

Considering the advancement in the diagnosis and treatment of glomerular disease, we formed a Glomerulonephritis Board (GN Board) at Cleveland Clinic that brings together key medical specialists who can collectively examine specific pathologic findings of complex glomerulonephritis cases, review current treatment approaches, and devise the most effective treatment regimen for salvaging functional renal parenchyma.

In addition, each specimen would be paired with clinical case data and banked information that could provide valuable insight into disease risk factors and mechanisms sometime in the future.

In the past five years, more than 700 patients underwent kidney biopsy at Cleveland Clinic for the evaluation of glomerular diseases. In addition, a number of kidney biopsies performed outside Cleveland Clinic were submitted to our pathology department for review.

The GN Board reviews individual cases from within Cleveland Clinic and offers an opportunity for outside nephrologists and patients to submit specimens for evaluation. Once the specimens are linked to clinical data, the board suggests treatment recommendations based on biopsy structural findings and up-to-date results from treatment trials.     

This GN Board's approach to the diagnosis and treatment of glomerulonephritis requires a team of specialists in nephrology, pathology, vasculitis, rheumatology and immunology, and genetics who are committed to improving our understanding of the structural changes caused by parenchymal injury and to assessing known clinical trials results. Tracking responses to renal injury treatment over time with a link to banked material will facilitate future opportunities for predicting therapeutic response and ongoing injury despite treatment.  

Generally, patients do not participate in board presentations, but there are plans to invite patients in selected cases. The board provides feedback to referring physicians outlining its opinion and treatment recommendations. All treatment recommendations would involve agents and strategies described in clinical trials throughout the world.

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