Renal Therapy
A broad range of therapy is available for treating patients with glomerulonephritis. While the past decade has seen the refinement of protocols using steroids and traditional cytotoxics such as cyclophosphamide, cyclosporine and azathioprine, the department is now making available newer immunosuppressives such as tacrolimus, mycophenolate mofetil and rapamycin in the therapy of glomerular disease.
The department has long held an interest in anti-platelet therapy particularly in the treatment of Ig A nephropathy. It has been responsible for producing Level-1 evidence in the use of low dose warfarin and persantin at anti-thrombotic doses to reduce proteinuria and to prolong renal survival for patients with this disease.
The department also employs widely strategies that inhibit the renin angiotensin system, using both angiotensin converting enzyme inhibitors as well as angiotensin receptor blockers as part of its armamentarium in renal therapy.
Hypertension Clinic
The Department conducts a Hypertension Clinic every Monday afternoon. It was established to evaluate patients with hypertension and to screen them for secondary hypertension, particularly for those suspected of having renovascular or reno-parenchymal hypertension. It investigates and manages patients with resistant hypertension or labile hypertension, as well as those with chronic renal impairment and hypertension.
24-hour ambulatory blood pressure monitoring is offered for selected patients. In particular, this form of monitoring is indicated for patients suspected of white coat hypertension, or those with apparent drug resistance, or have hypotensive symptoms from anti-hypertensive therapy or episodic hypertension or autonomic dysfunction.
Peritoneal Dialysis Programme
The peritoneal dialysis (PD) programme has been in existence since the late 1990s. As of 1997, 17.2% of all prevalent dialysis patients in Singapore were on peritoneal dialysis. Peritoneal dialysis offers an alternative modality of treatment for the patient with end stage renal disease, and brings with it the advantage of home based therapy, a means of prolonging residual renal function as well as cardiovascular-stable therapy particularly in patients with established cardiomyopathy or significant coronary vessel disease.
Most patients are on continuous ambulatory peritoneal dialysis (CAPD). Over the years, the switch from straight-line systems to the twin bag systems has seen a concomitant reduction of infection rates. The PD unit is heavily involved with patient teaching programmes, not only at the time of entry into PD, but also with continuous updates on at least a biannual basis for prevalent patients. The care of PD patients requires a multidisciplinary effort, and all patients are reviewed and counselled by the PD nurse, the hospital dieticians, and reviewed also by psychologists and supported further by the medical social workers. The department is now looking into the use of newer dialysates such as icodextrin and amino based dialysates to enhance peritoneal ultrafiltration as well as reduce the problems of malnutrition especially in the setting of peritonitis or ultrafiltration failure.