Achieving optimal fluid balance for a patient undergoing major surgery, especially transplant surgery, has always been the lofty goal of peri-operative care,1 which often proves to be an elusive target. While keeping the patient well hydrated improves organ perfusion, being too generous with fluids can result in morbidity, such...

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...

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...

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.

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...

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...

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.

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...

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 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.

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...

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 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...

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 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...

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...

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...

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...

Kidney transplants have been carried out in Singapore for more than 35 years, with the first cadaveric kidney transplant operation performed on 8 July 1970. However, prior to the commencement of the Human Organ Transplant Act (HOTA) in 1988, there was only a small number of kidney transplants; between...

A 45-year-old Singaporean was seen for review by a nephrologist at a restructured hospital. She had been on follow up by a private nephrologist for management of chronic renal failure (CRF) due to diabetes mellitus. This article is available only as a PDF. Please click on “Download PDF” on top...

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....

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...

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...

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...

Kidney transplantation is the best treatment for end-stage kidney failure. In comparison to dialysis, it offers the greatest potential for longevity and a superior quality of life. The first kidney transplant was performed in Singapore on 8 July 1970.1 Over the next 6 years, only 17 deceased donor (DD)...

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...

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....

Malaysia is a country with an intermediate burden of tuberculosis (TB) with a prevalence of 121 cases per 100,000 population per year. TB usually presents with fever, chronic cough, weight loss and lack of appetite, dypsnoea and night sweats. This article is available only as a PDF. Please click on...

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...

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 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...

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...

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...

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”...