Diagnosis and treatment of C3 glomerulopathy in a center of expertise.

C3 glomerulopathy is a rare renal disease that has been distinguished as a renal disease for about 10 years. It is caused by an excessive activation of the alternative complement pathway in the circulation, which leads to deposition of complement factor C3 in glomeruli. It is diagnosed based on clinical presentation, histological patterns in a kidney biopsy and tests of the complement pathways. It can closely resemble immune complexmediated glomerulonephritis and postinfectious glomerulonephritis. Renal failure develops in up to half of all patients within 10 years after presentation. A curative treatment is not available. Treatment relies on renoprotective measures, occasional immunosuppressive medication and experimental novel complement inhibitors. Because the disease is rare, its care and cure are concentrated in centers of expertise. Here we provide an overview of the state-ofthe-art diagnosis and treatment of C3 glomerulopathy in a center of expertise in the Netherlands.

Regional variation in the practice of euthanasia and physician-assisted suicide in the Netherlands.

BACKGROUND: The practice of euthanasia and physicianassisted suicide has been compared between countries, but it has not been compared between regions within the Netherlands. This study assesses differences in the frequencies, characteristics, and trends of euthanasia and physician-assisted suicide between five regions in the Netherlands and tries to explain the differences by demographic, socioeconomic, and health-related differences between these regions. METHODS: Data on the frequencies, characteristics, and trends of euthanasia and physician-assisted suicide for each region and each year from 2002 through 2014 were derived from the annual reports of the Regional Review Committees. Averages and trends were determined using a regression model with the regions and years as independent variables. Demographic, socioeconomic, and health-related variables for each region and each year were derived from the Central Bureau for Statistics and added to the model as covariates. RESULTS: The frequencies, characteristics, and trends of euthanasia and physician-assisted suicide differed between the regions, whereas the frequencies of non-assisted suicide did not differ. Euthanasia and physician-assisted suicide were most frequent and were performed most often by general practitioners, in patients with cancer, in the patient's home, in North Holland. The regional differences remained after adjustment for demographic, socioeconomic, and health-related differences between the regions. CONCLUSION: More detailed research is needed to specify how and why the practice of euthanasia and physicianassisted suicide differs between regions in the Netherlands and to what extent these differences reflect a deficiency in the quality of care, such as other forms of regional variation in health care practice.