Table 6.
Patient evaluation form to assist transition care
| Category | To evaluate | |
|---|---|---|
| Medical history | Disease characteristics | Age of onset, FRNS or SDNS, number of relapses, last relapse date, time of response to PDN |
| Medication history | Dosage of PDN for remission induction, current medication, cumulative dosage of PDN, CNIs, cytotoxic agents, cytostatic agents, anti-CD20s, other biologics | |
| Complications of the disease | History of AKI, thrombosis | |
| Side effects of medications | Multiple; e.g., skin, growth, infections, mental problems | |
| Kidney biopsy | Date of biopsy, review of biopsy report; discuss with pathologist if in doubt | |
| Physical examination |
Blood pressure Anthropometry Body mass index General physical exam |
Hypertension, growth failure, obesity, striae, skin problems, gum hypertrophy, hirsutism, hair loss/alopecia |
| Laboratory evaluation | Blood chemistry | Kidney function impairment |
| Blood lipid | Dyslipidemia | |
| Blood cell count | Neutropenia | |
| IgG (antiCD20mAb user) | Hypogammaglobulinemia | |
| Blood glucose, Hb A1c | Diabetes mellitus | |
| ANCA (levamisole user) | Vasculitis | |
| Radiologic evaluation | Consider DEXA in patients with low muscle mass, frail or low intensity fractures | Osteopenia/osteoporosis |
| Consultation; when indicated from medical history | Ophthalmologic evaluation | Cataract, glaucoma |
| Cardiologic evaluation | Pulmonary hypertension, venous insufficiency (thrombosis history) | |
| Social & other considerations |
Education/occupation/lifestyle Quality of Life Ongoing support by psychologists, social workers etc Knowledge of self-management |
Friends, partners, menstrual cycle Planned parenthood |