August 2019 marked the one-year anniversary of the UW Health Lupus Nephritis Clinic, the only clinic in Wisconsin serving patients who have renal complications from lupus—and one of only five of its kind in the nation.

After a year of experience leading this innovative clinic, co-founders Tripti Singh, MD, assistant professor (CHS), Nephrology, and Shivani Garg, MD, MS, assistant professor (CHS), Rheumatology, pictured above, reflected on its successes and challenges so far, and shared their goals for the future.

A collaborative, coordinated approach

Recognizing the multidisciplinary needs of patients with lupus nephritis—who need to see multiple specialists, undergo diagnostic and follow-up lab testing and adhere to a complex medication regimen—Drs. Singh and Garg worked hard in the first year to align locations, schedules and staff.

They hold the clinic one day per week, and when patients come for a visit, they see Dr. Singh (or Sarah Panzer, MD, assistant professor, Nephrology) along with Dr. Garg on the same day. This way, the team can order one set of lab tests, create a coordinated care plan and communicate more effectively with patients.

Because the lupus nephritis clinic shares space with the main lupus clinic, they’ve also cross-trained the nurses and medical assistants on the nephrology-specific aspects of the disease.

“We had them go to the nephrology clinic, where they learned more about to work with nephrologists, and how to identify patients’ needs so they could direct them to the appropriate services,” explained Dr. Singh.

“We’ve seen the staff grow as the clinic is growing,” added Dr. Garg.

Managing a chronic disease

According to the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Disease, nine out of 10 people who have lupus are women, and the disease most often strikes during the child-bearing years. African Americans and Asian Americans are also about two to three times more likely to develop lupus than Caucasians.

Of adults who have lupus, as many as half have lupus nephritis. Keeping up with the medication regimen for lupus nephritis is critical for preventing end-stage renal failure—but can be overwhelming for patients.

“Once a patient is diagnosed with lupus nephritis, they get started on six different medications, many of which have side effects, and have multiple follow ups with different specialists,” explained Dr. Garg.

“And when a patient in the prime of their life receives a diagnosis of a chronic disease like lupus nephritis, it can be very hard to accept,” she continued. “It’s not something you can see, so it’s hard to know that the medications are working.”

Social worker Jamie Guerrettaz, MSW, CAPSW, recently joined the team to help patients overcome those challenges. She helps patients navigate the health system, arranges transportation to clinic visits and identifies resources to support patients if the disease becomes disabling.

Positive outcomes for patients, learners and providers

Today, Drs. Singh and Garg are starting to see the positive outcomes of their collaboration. They estimate that in the first year, clinic volume has doubled from 50 to 100 patients.

In that same time period, they’ve also reduced patients’ wait time to biopsy from 52 days to less than 10 days. That’s important because the sooner a patient suspected to have lupus nephritis can receive a kidney biopsy, the sooner they can receive a diagnosis and begin treatment if needed.

The clinic also provides an outstanding opportunity for nephrology fellows, who learn a comprehensive approach to treating patients with lupus nephritis and gain valuable exposure to the clinic’s innovative model of care. Drs. Singh and Garg also intend to offer a rotation in the clinic for internal medicine residents and medical students.

In the future, they hope to bring a pharmacist onto the clinic staff to supplement the efforts of pharmacy students who currently assist patients with medication questions.

“Getting resources for a new clinic takes time, but everyone has been supportive,” reflected Dr. Singh. “And just being in the clinic with Dr. Garg—having another provider on your team—helps you learn a lot more.”

Resources:

• UW Health lupus nephritis clinic
• "From Concept to Clinic: Rheumatologists Launch and Lead Disease-Specific Medical Clinics," Department of Medicine, November 15, 2018.

Banner: UW Health Lupus Nephritis Clinic co-founders Tripti Singh, MD, and Shivani Garg, MD, MS. Credit: Clint Thayer/Department of Medicine.