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Continuous Renal Replacement Therapy: Continuous Blood Purification in the Intensive Care Unit

The last decade has seen a progressive change in the style of management of severe acute renal failure (acute renal failure which requires the use of renal replacement therapy) as well as in the epidemiology of this condition. Severe acute renal failure (SARF) is now most commonly seen in...

The Role for Preoperative Localisation Techniques in Surgery for Hyperparathyroidism

Hyperparathyroidism is well recognised as a clinical problem that has a myriad of presentation. The classical presenting symptoms of hypercalcaemia have been well documented but there is an even greater awareness that many non-specific symptoms like fatigue, depression and constipation are related to hypercalcaemia. This article is available only as...

Outcome of Tunnelled Central Venous Haemodialysis Catheters Inserted by Radiologists

In end-stage renal failure patients, maintaining adequate vascular access continues to be an ongoing challenge. Native arteriovenous fistulas or synthetic arteriovenous grafts are satisfactory long-term options. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

A Case Series of Falciparum Malaria-induced Acute Renal Failure

Predominantly a disease of hot and humid climates, malaria affects 270 million people worldwide annually, and has a mortality rate of 1%. The increasing morbidity and mortality attributable to malaria in recent years follows the loss, in the early 1970s, of the impetus and impact of the initial WHO...

Renal Cell Carcinoma in Patients with Chronic Renal Failure

Dunnil and associates first described the association of renal cell carcinoma (RCC) with acquired cystic kidney disease (ACKD) and end stage renal disease. The incidence of ACKD in dialysis patients ranges from 10% to 90% depending on the duration of dialysis. This article is available only as a PDF. Please...

Inferior Vena Cava Thrombectomy for Renal Cell Carcinoma with Thrombus

A characteristic feature of renal cell carcinoma is the development of tumour thrombus extending into the inferior vena cava (IVC). This takes place in 4% to 10% of cases. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Current Therapeutic Strategies in Glomerulonephritis

Twenty years ago, the therapy of glomerulonephritis (GN) was relatively simple as it was believed that treatment with prednisolone should be confined to patients with minimal change nephrotic syndrome and lupus nephritis. For those patients who failed to respond, they were treated with oral cyclophosphamide. This article is available only...

Preliminary Results of Heart-beating and Non-heart-beating Donor Kidney Transplants—The Singapore Experience

End stage renal failure (ESRF) is the most common end stage organ disease treated with transplantation in Singapore. Though renal transplantation is the preferred treatment for ESRF, organ shortage is a major obstacle. This article is available only as a PDF. Please click on “Download PDF” on top to view...

The Role of Cytokines and Cytokine Gene Polymorphism in T-cell Activation and Allograft Rejection

Cytokines are peptide molecules that are responsible for intercellular signalling during immune activation events. Cytokines are responsible, in large part, for the regulation of all local and systemic immune inflammatory and immunoregulatory events. This article is available only as a PDF. Please click on “Download PDF” on top to view...

Proteinuria and Angiotensin Converting Enzyme (ACE) Gene Polymorphism

Proteinuria is considered a marker of renal disease. Traditionally it has been thought that proteinuria is the result of diseased glomeruli. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Genetics of Immunoglobulin A Nephropathy

Immunoglobulin (Ig) A nephropathy is the most common primary glomerulonephritis in various parts of the world, and it was detected in 25% of biopsy specimens taken from children in Kobe University Hospital. IgA nephropathy was initially considered to be a benign disease with a favourable prognosis, but as data...

Case Reports of Low Dose Cyclosporine A Therapy in Adult Minimal Change Nephrotic Syndrome

There have been many reports on the use of conventional doses of cyclosporine A (CsA) in inducing remission among adults with minimal change nephrotic syndrome (MCNS), including those who fail steroids and cyclophosphamide therapy or who are steroid dependent and frequent relapsers. We report 3 cases which demonstrate the...

The Course of Pregnancy in a Patient with Nail-Patella Syndrome

The nail-patella syndrome (NPS) is a rare autosomal dominant disorder defined by the association of nail dysplasia, bone abnormalities and, frequently, renal disease. We report the course of pregnancy in a patient with such a condition. This article is available only as a PDF. Please click on “Download PDF” on...

Pregnancy after Renal Transplantation: Experience in Singapore General Hospital

Successful renal transplantation significantly improves the sexual and reproductive functions of women with end-stage renal disease and offers the best hope for those who wish to have children. Conception rate has been reported to improve dramatically from 1 in 200 dialysis patients to 1 in 50 women with a...

Seasonal Variations of Clinical and Biochemical Parameters in Chronic Haemodialysis

Seasonal variations in the general population in some body functions and diseases incidences have been well-established (e.g., vitamin D levels, allergic rhinitis, blood pressure, levels of physical activity and energy expenditure, mental depression, peptic ulcer disease, and death from chronic heart failure). Similar patterns of seasonal variations in some...

Molecular Adsorbent Recirculating System (MARS)

Liver failure is clinically heterogeneous in aetiology, pathophysiology, clinical severity and prognoses. It can be divided into the following categories: acute liver failure (ALF), of which the most severe form is fulminant hepatic failure (FHF); acute-on-chronic liver failure (AoCLF), such as acute viral hepatitis flare in those with chronic...

Hand-assisted Laparoscopic Living Donor Nephrectomy

Minimally invasive donor nephrectomy using laparoscopic techniques has become a very attractive method of procuring kidneys from live donors, compared to the traditional standard open surgical approach. The laparoscopic approach to live donor nephrectomy has advantages of decreased postoperative pain with lesser analgesic requirement, less surgical trauma, shorter hospitalisation...

3rd College of Physicians’ Lecture – Translational Research: From Bench to Bedside and From Bedside to Bench; Incorporating a Clinical Research Journey in IgA Nephritis (1976 to 2006)

In our quest to pursue knowledge regarding a patient’s illness or seek a cure for the disease, as doctors we have to derive the necessary answers through physical examination of the patient and investigations either at the bedside or the laboratory. We engage in research activities into the patient’s...

Angiotensin-Converting Enzyme Inhibitor versus Angiotensin 2 Receptor Antagonist Therapy and the Influence of Angiotensin-Converting Enzyme Gene Polymorphism in IgA Nephritis

Angiotensin converting enzyme inhibitors (ACEI) and angiotensin II receptor antagonists (ATRA) are both well established drugs utilised to help retard the progression of chronic kidney diseases to end-stage renal failure (ESRF), either by reducing proteinuria or even reversing mild renal impairment and restoring normal renal function in some cases....

ANCA-negative Pauci-immune Crescentic Glomerulonephritis with Thrombotic Microangiopathy

Pauci-immune crescentic glomerulonephritis (Pauci-immune CGN) is the most common cause of CGN. Thrombotic microangiopathy (TMA) defines a clinicopathological syndrome consisting of intraluminal platelet thrombosis in the microvasculature and the presence of fragmented red blood cells and thrombocytopaenia in the peripheral blood, and may be seen in haemolytic uraemic syndrome...

Urotensin 2 and Retinoic Acid Receptor Alpha (RARA) Gene Expression in IgA Nephropathy

IgA nephropathy (IgAN) is the most common primary glomerulonephritis in Singapore1 and in many parts of the world, contributing significantly to the pool of end-stage renal failure patients annually. Despite more than 3 decades of research, the pathogenesis of the disease is still poorly understood. This article is available only...

Epidemiology and Management of Surgical Upper Limb Infections in Patients with End-stage Renal Failure

Hand infections are common in the general population, and their management is usually uncomplicated. Several papers have noted that patients with diabetes mellitus have more severe infections, a different spectrum of bacteriology and a worse outcome. In our experience, of all patients with upper limb infections, those with end-stage...

Novel Trends in Haemodialysis: Where Are We Heading?

Despite advances in haemodialysis technology over the past 40 years and rapid proliferation of clinical guidelines over the last decade promoting evidence-based practices, the mortality of end-stage renal failure patients on conventional thrice-weekly in-centre haemodialysis remains remarkably high. This article is available only as a PDF. Please click on “Download...

Triplicate Ureter with Contralateral Duplicate Ureter

What do you see in this intravenous urogram? 1. Left lower ureteric calculus with proximal hydroureteronephrosis 2. Left duplicated ureter with lower ureteric calculus 3. Right triplicate ureter with left duplicated ureter 4. Right triplicate ureter with left duplicate ureter with left lower ureteric calculus with proximal hydroureteronephrosis This article is available only as a PDF....

Profile of Hospitalisation and Death in the First Year after Diagnosis of End-stage Renal Disease in a Multi-ethnic Asian Population

End-stage renal disease (ESRD) is reaching epidemic proportions and is increasingly a public health issue due to the cost of providing care to these patients. There are many kidney disease databases and registries tracking and studying trends in the epidemiology and care of ESRD patients. This article is available only...

Primary Hyperoxaluria

An 18-year-old male presented with complaints of abdominal pain. He had history of previous episodes of renal colic and passage of stones in urine. Renal function tests were deranged (blood urea levels of 72 mg/dL and serum creatinine levels of 3.2mg/dL). Abdominal X-ray (Fig.1) and non-contrast computed tomography (NCCT)...

Kidney Cancer and Diabetes Mellitus: A Population-Based Case-Control Study in Taiwan

Kidney cancer accounts for 3% to 4% of all cancers. In a systematic review by Mathew and et al,2 the incidence of kidney cancer was the highest in France (16.1 per 100,000 man-years) and the lowest in India (0.9 per 100,000 woman-years) during 1988 to 1992. A trend analysis in...

Prevalence of Chronic Kidney Disease in Adults with Type 2 Diabetes Mellitus

According to the National Health Survey, the percentage of Singapore residents with diabetes mellitus (DM) aged between 18 and 69 years has risen from 8.2% in 2004 to 11.3% in 2010. DM can lead to a myriad of long-term health complications such as coronary heart disease, kidney failure and...

Dietary Protein Intake in a Multi-ethnic Asian Population of Healthy Participants and Chronic Kidney Disease Patients

Clinical practice guidelines recommend different amounts of dietary protein intake for chronic kidney disease (CKD) patients. The recommended daily protein intake varies according to the level of kidney function (glomerular filtration rate (GFR) in mL/min per 1.73 m2 body surface area). It is unknown how effectively these recommendations perform...

Avulsed Tip of a Systemic Iceberg

An 18-year-old male presented to the emergency department of Khoo Teck Puat Hospital with knee pain and swelling while playing basketball. He was unable to bear weight. He had a surgical history of combined liver and kidney transplant 3 years ago. This article is available only as a PDF. Please click on “Download PDF”...