Nephrology

The Division of Nephrology is engaged in a number of important translational research initiatives, including defining the epidemiology and long term outcomes of acute kidney injury in children and infants, the mechanisms of kidney injury and the outcome of babies born with congenital kidney malformations, the mechanisms of scarring in progressive kidney disease, the role of hypertension in the progression of chronic kidney disease in children, the importance of medication adherence to outcomes in kidney transplantation in teens, non invasive markers of rejection in kidney transplant patients, and the factors which impact on the progression of chronic kidney disease in children.

In that regard, members of the Division are local, national, and international leaders in their areas of research and are actively engaged in multicenter collaborative efforts including neonatal and pediatric intensive care consortia for the study of acute kidney injury (AWARE, AWAKEN), national and international collaborations in the development of best practices for a number pediatric kidney diseases including glomerulonephritis, nephrotic syndrome, and hypertension (CKiD, STOPP, KDIGO), the development and identification of biomarkers in childhood cancer (ABLE) and kidney transplantation (PROBE), and national collaborations in transplantation research programs including the Canadian National Transplant Research Program, TAKE-IT, and PROBE.

In support of their research, Division members have received operating grants and financial support from the Canadian Institutes of Health Research, the Kidney Foundation of Canada, the National Institutes of Health, the Dean of Medicine and Establishment Awards, the Children’s Hospital Foundation Telethon, the Clinic Research Capacity Building Award from the BC Children's Hospital Research Institute, as well as training grants from the National Science and Engineering Research Council and summer studentship awards from the BC Children's Hospital Research Institute. The Division continues to provide elective and research training to undergraduate and postgraduate students.

The Division is actively involved in UBC undergraduate medical school teaching, with leadership roles in course and curriculum development in the first and second years. Postgraduate training for Pediatric residents is an integral component of the Nephrology outpatient teaching experience. Pediatric residents rotate through an elective rotation in Nephrology ambulatory care annually. This rotation is designed to give residents experience in out-patient Nephrology as well as in-patient/ on-call subspecialty care. There are five half-day clinics per week including general nephrology, chronic kidney disease, and renal transplantation. When not in clinic seeing patients, residents use the time for dictations, reading, preparing their presentation, or attending scheduled rounds. One week of the elective the resident will be assigned to the in-patient/ on-call service. During this time they will be responsible for rounding on ward patients, seeing consults on wards and ER, and being first call for ward issues. At the end of their elective the resident will also be required to give a 30-minute presentation to the division. The renal subject is the choice of any Nephrology topic that interests them and that will enhance their own knowledge. This elective has consistently been highly rated.

The Division of Nephrology also offers an accredited Royal College of Physicians and Surgeons training program in Pediatric Nephrology. Full training in Pediatric Nephrology is achieved by a program of graded responsibilities and learning experience which fulfill the central roles of medical expert, communicator, collaborator, manager, health advocate, scholar and professional, necessary to the specialist. The first clinical year is structured to provide exposure to the whole range of nephrology: hemodialysis, peritoneal dialysis, transplantation, renal pathology, fluid and electrolyte management and general consultative nephrology. The second year is dependent upon the resident’s goals. There are appropriate support facilities and personnel to ensure there is a breadth and depth of exposure: laboratory and pathology rotations are excellent, radiology and nuclear medicine interaction occur frequently both formally and at uroradiology rounds. An optional third year is recommended for those trainees interested in pursuing further basic or clinical science training. We offer trainees an opportunity to work and train within a large, diverse and well staffed series of multi-disciplinary clinics with health professionals from a variety of fields, including social work, dietitians, psychologists, psychiatrists, dedicated transplant and dialysis nurses, ethicists, and related subspecialists. All fellows or trainees are expected to perform a research project during their time in the program and many have chosen to pursue further research training under mentorship within the division or outside of it. Our recent trainees have been involved in a number of varied clinical research projects, with multiple presentations at major meetings, and publications in peer-reviewed Nephrology journals.

To inquire about our fellowship program, please call 604-875-2272

Members of the Division hold cross-appointments in UBC graduate studies programs and are available to provide supervision of graduate and postgraduate medical science trainees.

Division members participate in a number of Nephrology teaching rounds including weekly Clinical Teaching Unit rounds, weekly in-patient rounds, monthly Nephrology journal clubs, biweekly combined urology/radiology/nephrology rounds, monthly kidney biopsy rounds, annual Pediatric Grand Rounds, Pediatric resident academic half days, Nephrology fellow academic half days, and Departmental Advances in Pediatrics.

There have been many achievements in the Division’s Clinical Care Program over the years, including the assembly of highly skilled multidisciplinary teams of specialty clinic physicians, nurses, dietitians, pharmacists, and social workers, the establishment of specialty out-patient clinics, and the evolution of a shared care model of practice. To enable its clinical, educational, and research missions, the Division moved to a Shared Care Program in which clinics are attended by more than one physician, and where patient care is consultative, collaborative, and shared. The physician on service and/or on call attends to the care of the hospitalized patient. Additionally, in order to gain efficiencies in care, to improve outcomes, and to enhance teaching and education, specialty Nephrology clinics have been developed. There are presently a number of half-day clinics offered per week, including dedicated clinics for chronic kidney disease, kidney transplant, general referrals, nephrotic syndrome, hypertension, and a combined renalrheumatology clinic.

The ambulatory care clinics see approximately 2000 visits per year. Of these, 1200 visits are follow-up evaluations in the General Nephrology clinics with approximately 350-400 new referrals annually. Within this group we have recently developed dedicated clinics for the care of our children with nephrotic syndrome (75-100 active patients), hypertension, and a combined renal-rheumatology clinic. Our Chronic Kidney Disease clinics provide care for approximately 150 children identified as having decreased kidney function (< 60 ml/min/1.73m2) but not requiring dialysis. Our Kidney Transplant clinic is the model upon which the Multi Organ Transplant clinic has been built. It sees approximately 350 visits per year and serves a population of approximately 50 active patients.

Our Dialysis program offers both hospital and home-based therapies. Our hospital-based hemodialysis unit provides over 1000 dialysis treatments for approximately 6 children per year, in addition to providing hemodialysis treatment support to the Pediatric Intensive Care Unit. We have a dedicated state of the art pediatric hemodialysis unit, which will be relocated to the third floor of the new TECK Acute Care Building of the Children’s Hospital. Our home-based dialysis program provides care for up to 15 children on peritoneal dialysis. The Chronic Kidney Disease, Transplant, and Dialysis programs are resource-intensive and are staffed by highly skilled multidisciplinary care teams with dedicated Medical Directors.

To learn more about our Renal Program and our clinic, please visit: http://www.bcchildrens.ca/health-professionals/clinical-resources/renal-program.

Quality

The Quality Program of the Division incorporates best practices and responds to all incidents of harm. It sets and prioritizes Divisional quality improvement, patient safety, and, in conjunction with the Nephrology Clinical Pathway Development Committee, clinical pathway objectives and goals. It was developed to identify and address potential/actual issues that affect the quality of care delivered including assessments provided by the Nephrology clinical care teams. It has a responsibility to communicate the results/recommendations of the review activities to all clinical team members, to recommend changes to practice and assist with implementation of changes, to ensure quality, safety, and clinical pathway improvement strategies and initiatives are implemented, evaluated and sustained, and to report on the quality of service provided in the Nephrology programs. The Quality Director reports directly to the Division Head of Nephrology and regularly to Division members through the Division Meeting which occurs at least 4 times per year. The Division Head then reports to the Child Health Quality of Care Committee as required.

With a commitment to quality and excellence in clinical care, the Division of Nephrology’s Clinical Pathway Development (CPD) Team was established to help transform established best practices and innovative research findings into standardized clinical care and improved patient outcomes. The CPD Team endeavours to elevate the patient care experience by empowering pediatricians, primary care physicians, allied health practitioners, and patients and families themselves, with cutting edge knowledge, exceptional care, and uncompromised quality. The overarching goal of the Clinical Pathway Development Team is to ensure the health, safety and well-being of the patients and families cared for by the Division of Nephrology. Underpinning this goal is the CPD Team’s commitment to continuing education, change management, knowledge translation, quality improvement, and clinical research. More specifically, the CPD aims to: (1) critically review available evidence; (2) establish consensus and make evidence based-recommendations for practice in the form of clinical pathways; (3) develop the necessary tools and resources needed to support the effective education, dissemination, and evaluation of the pathways; (4) audit end-user fidelity to and satisfaction with the pathways; (5) iteratively re-evaluate and update the pathways as new evidence becomes available, and; (6) support ongoing research initiatives in the fields of clinical pathway theory and pediatric nephrology.

Since its inception in 2011, an important focus of the CPD Team has been the evolution of the Childhood Nephrotic Syndrome (CNS) Clinical Pathway – a structured, evidence-based, and prescriptive care plan detailing the essential steps to be taken by various care providers for the management of children with nephrotic syndrome. Numerous resources and programs have been produced as part of the CNS Pathway. Collectively, these resources have allowed for highly efficient patient care, uniquely broad yet focused learning opportunities for students and trainees, and increased adherence to CNS Pathway recommendations by health care practitioners and patients themselves. Moreover, the CPD team continues to share and promote the CNS Pathway at local, national, and international forums. A guiding modus operandi for the CPD Team has been to push current practices towards, and indeed beyond, the best-available standards. To this end, future directions of the CPD Team include not only the progression of the CNS Pathway, but also the development of unique pathways for the other renal conditions typically seen within the Division of Nephrology, including but not limited to hypertension, childhood glomerulonephritis, and congenital kidney anomalies diagnosed in the antenatal period.

For more detailed information on our patient care programs, please visit: http://www.bcchildrens.ca/health-professionals/clinical-resources/renal-program

Regional Care

In conjunction with Child Health BC and the local heath authorities, the Division of Nephrology continues to develop and promote regional care for children with kidney disease and their families throughout British Columbia.  The regional care program has dedicated resources supporting a pediatric nephrology specialty nurse, dietitian, and clerk. Regions served by a Pediatric Nephrology clinic include the Fraser Health Authority at the Surrey Memorial Hospital, the Northern Health Authority at the University Hospital of Northern British Columbia in Prince George, and clinics are now being developed in the Interior Health Authority to operate out of Kamloops and Kelowna.

Faculty:
Scott E. Wenderfer, MD, PhD, FASN (Division Head)
Robert Humphreys, MD FRCPC (Fellowship Program Director)
Allison Eddy, MD, FRCPC (On Administrative Leave)
Douglas G. Matsell, BSc, MDCM, FRCPC
Tom Blydt-Hansen, MDCM, FRCPC
Janis Dionne, MD, FRCPC
Eleonora Jugnauth, MD
Cherry Mammen, MD, FRCPC
Matt Harding, MD
Mina Matsuda-Abedini, MD, FRCPC
Susan Samuel, MD, FRCPC

Nurses:
Lori Paille, Clinical Nurse Coordinator
Jessie Ahuja, Transplant Nurse
Sarah Fay, Transplant Nurse
Marijana Kraljevic, Transplant Nurse
Jennifer Leechik, Renal Nurse Clinician, Peritoneal Dialysis
Sam Badock, Renal Nurse Clinician/Hemodialysis Nurse
Leslie Haynes, Hemodialysis Nurse
Lorraine Paz, Hemodialysis Nurse
Kathleen Smiley, Hemodialysis Nurse
Laura Griffiths, Clinical Nurse, Regional Clinics
Carly Lecuyer, Clinical Nurse
Rupinder Toor, Clinical Nurse

Nephrology Fellows:
Khalid Taha, MD
Asim Almotawa, MD
Simple Kakar, MD
Punit Chajjed, MD

Social Workers:
Kat Broad
Meabh Neville

Dietitians:
Meredith Cushing, RD
Kirsten McFadyen, RD
Nonnie Polderman, RD
Natalie Sousa, RD

Pharmacists:
Katie Haubrich (on leave)

Psychologist:
Anisha Varghese

Child Life:
Rita Marchildon

Research Staff:
Marisa Catapang, Research Coordinator

Administrative Services:
Alice So, Administrative Secretary
Theresa Wong, Chronic Kidney Disease (CKD) Clinic (on leave)
Susan Harkins, Chronic Kidney Disease (CKD) Clinic
Kim Wheatley, General Nephrology Clinic
(Under recruitment) Multi-Organ Transplant Clinic
Celine Magrata, Regional Clinics
Janica Carolina, Clerk
Francesca Mastandrea, Registration Clerk

Fellowship Program:
Robert Humphreys, MD FRCPC, Fellowship Program Director
Division of Nephrology
4480 Oak St., BCCH
Vancouver, BC V6H 3V4
Telephone: 604-875-2272
Fax: 604-875-3649
Email

Contact:
Division of Nephrology
4480 Oak St., BCCH
Vancouver, BC V6H 3V4
Telephone: 604-875-2272
Fax: 604-875-3649