New Multidisciplinary Clinic for Vasculitis Patients at UPMC Combines Rheumatology and Nephrology Teams for Comprehensive Care
April 24, 2023
Vasculitis, in its many forms, remains a rare disease with, in most cases, idiopathic origins and, as yet, no curative options for patients. Treatments for the spectrum of the disease rely mainly on a combination of glucocorticosteroids and immunosuppressive agents (e.g., rituximab) to achieve disease remission or symptom quiescence and alleviate the potential for long-term downstream effects on blood vessels and organ systems.
Many forms of vasculitis affect primarily small blood vessels in the body and its organs. The kidneys are particularly prone to potential damage from various forms of vasculitis due to their high density of small blood vessels. For patients with vasculitis – either newly diagnosed or long-term patients living with the disease, understanding the degree of kidney involvement in their disease process is crucial to maintaining kidney function and health throughout their lifetime.
To address the specific and long-term needs of vasculitis patients with kidney involvement or kidney-specific forms of vasculitis and for those patients who exhibit a high degree of risk for having future renal manifestations of the disease, a new, dedicated joint rheumatology-renal clinic for vasculitis patients was created at UPMC.
The UPMC Rheumatology/Renal Vasculitis Clinic is the product of a collaboration between Sebastian E. Sattui, MD, MS, assistant professor of Medicine and director of the UPMC Vasculitis Center, and Syeda B. Ahmad, MD, assistant professor of Medicine and medical director of the Glomerular Disease Clinic at UPMC.
The rheumatology-renal clinic for vasculitis began seeing patients in December 2023 and currently operates one day per month for newly diagnosed and existing patients, and for consultations with patients from referring physicians.
It’s the latest in a long-standing and growing list of multidisciplinary clinics launched by the Division of Rheumatology and Clinical Immunology with partners across UPMC and the University of Pittsburgh School of Medicine Divisions and Departments.
"The new clinic is designed to meet the needs of newly diagnosed patients and patients who have been living with vasculitis for years," says Dr. Sattui. "Because of the rarity of vasculitis, there are few facilities in the U.S. equipped to deal with the diverse and complex forms of the disease. This leads patients, in some instances, to travel significant distances to seek the kind of specialized care we offer at UPMC.”
Renal Involvement in Vasculitis – Monitoring and Protecting the Kidneys from Harm
While there are specific subtypes of vasculitis that primarily affect the kidneys, many other forms of vasculitis can and do adversely affect a patient’s renal function. Inflammatory processes and fibrotic changes in small vessels in the kidney can lead to damage to the glomeruli, which ultimately impairs and degrades kidney function. The process can happen rapidly, or it can develop slowly over time if left unchecked. Acute kidney injury, chronic kidney disease, renal failure, and the need for dialysis are all possibilities, and they can manifest at varying times.
“Vasculitis is a multiorgan, multisystemic disease, and unfortunately for some patients, even those without kidney-specific forms of the disease, renal involvement is a very common troubling downstream consequence,” says Dr. Ahmad. “Because of the propensity for vasculitis to affect the small vessels in the kidney – and ultimately the glomeruli – it's crucial to test for and monitor long-term kidney health in vasculitis patients and intervene with treatments to preserve and protect as much of their renal function and reserve as possible.”
Initial diagnostics for new patients are important for achieving a baseline understanding of their kidney health, and if significant impairments or damage is suspected, biopsies can further explore the extent of the disease.
"Long-term monitoring in established patients is just as important as the initial workup in new patients," says Dr. Sattui. “Vasculitis can precipitate changes over time, often without warning, which is why combining rheumatology and renal providers in a single clinic for these patients makes a great deal of sense.”
Streamlined, Patient-Centric Care
One of the driving factors spurring the creation of the new multidisciplinary clinic between Drs. Ahmad and Sattui was the need to simplify yet amplify the care vasculitis patients with kidney involvement receive by bringing both disciplines together for joint patient encounters and consultations. It may sound simple, but the approach has numerous benefits.
"We have patients in for one visit with both providers," says Dr. Sattui. "Less travel, less time away from home, family, or work means a lot, particularly to patients in our outlying areas who sometimes have to travel two or three hours for an appointment."
Patients meet with both providers concurrently, so they can efficiently obtain the entire picture around their disease state, symptoms, and treatments – how they are progressing individually, but also how they work in combination to preserve and protect long-term health.
“For a vasculitis patient with any degree of kidney involvement, it benefits them to hear from both providers at the same time,” says Dr. Ahmad. “We can explain the underlying vasculitis and their treatments in relation to the health of their kidneys and why that is so important for long-term health.”
There also is the aspect of individualized care. Vasculitis presents across such a broad spectrum that no two patients are the same, even those with similar diagnoses. Symptoms, treatment, and long-term outcomes vary widely.
"Patients living with a chronic disease like vasculitis, and in this case, those that also have some degree of kidney involvement, are a particularly vulnerable population,” says Dr. Sattui. “They need to know a great deal about their condition in order to maintain their health, so education is very important. We spend a lot of time, particularly with our newly diagnosed patients educating and answering questions."
Patient Referrals and Consultations
To learn more about the new clinic or to discuss a potential patient referral, please call 412-586-3550.
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