A multidisciplinary renal clinic for corticosteroid-induced bone disease.

A multidisciplinary clinic to manage complicated bone disease was established due to the high prevalence of osteoporosis in corticosteroid-treated patients with a history of organ transplantation or chronic glomerulonephritis. Assessments were performed by a renal clinical pharmacist, nephrology nurse, and rheumatologist. Of 70 patients (27 men, 43 women) evaluated from December 1997-June 1999, 37% had osteoporosis (30% spine, 23% hip, 16% both sites) and 34% had a history of fracture. Analysis revealed low 1,25-hydroxyvitamin D3 levels (15 patients), hormone deficiency (16), elevated parathyroid hormone (27), and history of taking at least one other risk drug in addition to corticosteroids (58). Thirty-nine percent of patients had a documented height loss (mean 1.0 in.). Other risk factors included 32 episodes of graft rejection requiring additional corticosteroids, history of smoking (24 patients), poor physical activity (40), and low dietary calcium intake (47). Drug interventions included calcium and/or vitamin D (44 patients), calcitonin (7), alendronate (20), and hormone replacement therapy (11). Preliminary results showed an increase in bone mineral density (a surrogate marker for fracture risk) of 3-5%. An organized clinic to assess osteoporosis risks can unmask a large population of patients with documented bone loss. Appropriate interventions such as drug therapy and lifestyle changes may increase bone mineral density. A long-term benefit of therapy, although not measured in this study, may be a decreased predisposition to fractures and their sequelae.

A multidisciplinary renal osteoporosis clinic: a new role for the nephrology nurse.

Osteoporosis is one form of osteodystrophy that may be treated and/or prevented with a comprehensive approach. At the University of North Carolina at Chapel Hill, we created a multidisciplinary kidney osteoporosis clinic with a nephrology nurse at the center of patient care. This article will describe the development of our clinic, our multidisciplinary approach to patient care, and how the nephrology nurse is uniquely qualified for the central role in the care of these patients. Preliminary outcome data is described, demonstrating the positive effect our clinic has had on patient care. A description of the pathogenesis and treatment of osteoporosis in renal patients is also given to provide background for the reader.

Hepatitis C virus and its impact on transplantation.

Hepatitis C virus is now the leading cause of serum hepatitis worldwide, a fact that has serious implications for the fields of dialysis and transplantation. This article describes hepatitis C transmission, diagnosis, clinical features and treatment, and explores the controversies and unique problems that hepatitis C presents to the field of transplantation.