Fish oil therapy in IgA nephropathy.

IgA nephropathy often progresses to endstage renal failure over a period of many years, and any therapy directed to IgA nephropathy will most likely have to be administered over an extended period of time. Therefore, optional therapy should be effective and free of long-term adverse effects. Besides fish oil, prednisone has also been investigated for treatment of IgA nephropathy, with a lack of consistent results; severe adverse effects are common with long-term use. Several studies have shown positive although not overly impressive results; therefore optimal therapy for slowing the progression of renal failure secondary to IgA nephropathy has not been established. Problematic issues with available studies included the following: (1) most of the clinical studies previously discussed were short-term, contained small numbers of patients, and most but not all were uncontrolled; (2) early reports involving fish oil therapy demonstrated conflicting results regarding its efficacy, including one study that observed increased progression of renal disease in patients treated with fish oil; however, recent studies have shown more promise for fish oil therapy for up to 2 years of treatment; and (3) since most of the studies were conducted over a short period of time, it is difficult to assess long-term effects and safety of oil treating IgA nephropathy, a disease that progresses to ESRD over 10-20 years. However, given the low number of adverse effects and apparent low risks associated with this relatively safe food supplement therapy observed in most clinical trials of up to 2 years duration, fish oil may slow the progression of renal failure in patients with IgA nephropathy. Therefore, with appropriate monitoring of renal function and blood tests, treatment with fish oil 6-12 g/d should be considered in patients with IgA nephropathy.

Developing a comprehensive medication reaction reporting system.

A step-by-step method for developing a comprehensive medication reaction reporting system is reported. The program was developed from information obtained by literature review, from the existing programs of other hospitals, and the authors' ideas. The following steps were developed and implemented after approval by the Pharmacy and Therapeutics Committee. The name of the program was changed from the Adverse Drug Reporting Program to the Medication Reaction Reporting Program. A voice mail system was installed, the medication reaction reporting form was revised, a suspected medication reaction sticker was developed, the peer review mechanism was revised, and a system for positive feedback to reporters was developed. After implementation of the revised program, the number of reported medication reactions increased by 144%, from an average of 12.7 reports per month to 31 reports per month. The revised program has increased medication reaction reporting from 1.2% to 2.7% of discharged patients. Program revision has also increased the quality of the reports, increased the number of cases for peer review, and has aided the medical center in identifying medication related problems which has resulted in closer monitoring to reduce future problems.