Pioneering Coordinated, Comprehensive Care at Arkansas Children’s Hospital

Conditions impacting pediatric patients, like chronic kidney disease or hypertension, are rarely localized to one system in the body. Arkansas Children's Hospital prioritizes treating complex and common conditions with a collaborative care model.

Richard T. Blaszak, M.D., chief of nephrology at Arkansas Children’s Hospital and associate professor of pediatrics at the University of Arkansas for Medical Sciences, said, “Our faculty recognized that to provide holistic care to families and to achieve superior outcomes, we needed to engage with our colleagues. We’ve been very thoughtful about doing that as we developed multidisciplinary clinics.”

UroNeph

The Urology Nephrology Clinic at Arkansas Children's Hospital is one of the few multidisciplinary clinics of its type in the nation. Providers in both clinics saw the value of coordinating care for patients with conditions ranging from posterior urethral valves (PUV) to cloacal anomalies. The two clinics preemptively collaborated to improve care for these important, somewhat fragile patients.

The UroNeph Clinic, as it’s known locally, was established in 2018 to improve patient care for those needing both services, which includes patients with PUV, vesicoureteral reflux, neurogenic bladder, kidney stones and more rare conditions like Hinman Syndrome, megaureter, and urogenital or cloacal anomalies.

The issues faced by patients with end-stage kidney disease illustrate how beneficial the multidisciplinary approach can be. Many have end-stage kidney disease because their lower urinary tract, either in utero or post-utero, was abnormal and led to an upper tract kidney abnormality.

Rachel Millner, M.D., a pediatric nephrologist at Arkansas Children’s Hospital and assistant professor of Pediatrics in the Division of Pediatric Nephrology at UAMS, said, “We’re targeting a very specific population of children. We’re offering very comprehensive care to a small subset of very complicated patients.”

Coordinating Care

Coordinating the care starts with monthly meetings during which the urologist, nephrologist and a dedicated nurse practitioner discuss the treatment needs and options for every patient. The result of these monthly meetings is a clear vision that can be communicated to a family and reduce the amount of time spent moving between clinics.

"Now they're standing there with a nephrologist, and they're standing there with a urologist, and we're telling them the exact same plan. It gives families peace of mind," Millner said.

Proactive Protocols

The UroNeph Clinic is poised to take a proactive approach to some of the conditions they see most frequently by developing screening protocols for detecting the earliest stages of a condition.

"The first protocol we're doing is for posterior urethral valves, and then we would talk about doing protocols for kidney stones and urinary reflux," Millner said. These protocols will also lay the groundwork for studying the conditions. "When we create these protocols, it makes it easier to do research because it creates a baseline so that it's much easier to follow changes."

The UroNeph Clinic yielded improved outcomes and increases in patient satisfaction, so the Nephrology and Rheumatology teams at ACH followed suit and collaborated to open a Vasculitis Clinic in 2021. The Vasculitis Clinic meets the needs of children with systemic lupus erythematosus (SLE) and related conditions, including IgA vasculitis, Kawasaki disease and ANCA-associated vasculitis.

Most recently, Arkansas Children’s Hospital has applied the collaborative care model to address the rise of kidney stones in pediatric patients by launching a dedicated Kidney Stone Clinic.

Pediatric Kidney Stones

The number of children with kidney stones has increased recently, especially in the southern region known as the Kidney Stone Belt, making the Arkansas-based Kidney StoneClinic an asset for children in the surrounding states.

"An adult kidney stone is often chalked up to diet and not drinking enough water," Millner said. "If children have kidney stones, it's more likely to be an underlying metabolic abnormality, so it is important for those children to be assessed by a nephrologist."

Cystic fibrosis and spina bifida are two common causes of kidney stones in children, which require different treatments than typical adult kidney stones. Specific pediatric needs include reducing sodium intake while increasing citrate intake through dietary changes or supplements in pill or liquid form.

The UroNeph Clinic, Vasculitis Clinic and Kidney Stone Clinic are just a few examplesof how Arkansas Children’s is leading the way in responding to the needs of children in the region with exemplary, innovative care.

Arkansas Children’s Hospital’s Chief of Nephrology, Richard Blaszak, M.D., said, “Our focus will continue to be developing these interdisciplinary care teams because we feel that’s important to advance the care of children.”