July

Recommendation 1 in the BC guidelines for chronic kidney disease[1] published in 2004 lists the following high-risk groups:

• Anyone with diabetes.
• Anyone with hypertension with or without cardiovascular disease.
• Anyone with a family history of kidney disease.
• Anyone of First Nations or Pacific Islands ethnic background.

In the current era of physician shortages, overbooked offices, antiquated fee schedules, and lengthy waiting lists for access to specialty care, the prospect of managing a patient with chronic kidney disease (CKD) can be daunting for the family doctor. Likewise, the nephrologist’s office is inundated daily with requests for assessment and assistance managing the burgeoning number of CKD cases.[1] In the Vancouver Island Health Authority, for example, these pressures have resulted in an average wait for elective nephrology consultation of 8 months (range 4 to 14 months).

British Columbia is the first multilab jurisdiction in the world to routinely analyze serum creatinine values using an equation that provides an estimate of the glomerular filtration rate (eGFR), and the first to initiate a broad-based creatinine testing standardization program. Because kidney disease evolves without notable signs or symptoms, a simple, reliable, objective test is required for case finding and categorizing severity. The eGFR has been selected as the essential marker for the new BC chronic kidney disease (CKD) clinical practice guidelines.

The 2004 West Nile virus (WNV) season turned out to be very mild in most of North America, with only 25 human cases across Canada. This compares to 1388 human cases in 2003. It is likely the cool, wet summer slowed the westward spread of the virus; however, in the US the virus did make its way into California and Oregon. Both of these states had large outbreaks of human illness. There was no WNV activity detected in BC in 2004 despite the extensive surveillance system established to monitor for it in mosquitoes, birds, humans, and other animals.

For more than 40 years the Canadian government has guaranteed medical care as a right to all Canadian citizens. This promise has not been honored for children and youth, and this needs to be rectified.