The Department of Renal Medicine, Singapore General Hospital is the oldest and largest renal department in Singapore. Established in 1973, the department had been at the forefront of nephrology care in Singapore over the years. Today, it is the premier referral centre for the evaluation and management of a range of kidney diseases. It has seven sub-specialty clinical programs that includes the Glomerulonephritis and Renal Vasculitis, Chronic Kidney Disease, Haemodialysis, Peritoneal Dialysis, Critical Care Nephrology, Renal Transplantation and Interventional Nephrology Program. The current Head of the Department is Clinical Assoc Prof Tan Chieh Suai.
The Department of Renal Medicine provides comprehensive evaluation and management of all types of kidney diseases including glomerulonephritis, diabetic kidney disease, cystic kidney disease and hypertension. In addition, patients with complex medical conditions that require specialist care from multiple disciplines, such as high risk pregnancy and autoimmune diseases, are seen in multidisciplinary clinics.
Pre-dialysis patients are seen at our dedicated Low Clearance Clinics that are supported by medical social workers, dieticians, pharmacists and renal coordinators to ensure a smooth preparatory journey for our patients who are approaching end stage kidney failure. In addition, the clinic is also supported by a Renal Supportive Care service to care for patients who opt for conservative care management who work closely with our community health partners.
Patients with severe mineral bone disease due to chronic kidney disease are also seen in a dedicated clinic with close collaboration to head and neck surgeons in the event parathyroidectomy is required. The department also provides real time ultrasound-guided kidney biopsies and 24-hour Ambulatory Blood Pressure monitoring services.
The Director of the Glomerulonephritis and Renal Vasculitis (GNRV) programme is Clinical Assoc Prof Jason Choo. The GNRV program builds on the work by Prof Woo Keng Thye who is an expert in IgA nephropathy providing patients with the option of participating in multicenter clinical trials offering new cutting-edge molecular treatments for various glomerular diseases. In addition to providing expert care for patients with glomerular diseases requiring immunosuppression, the program works in collaboration with our Rheumatology colleagues as part of a multidisciplinary clinic to manage patients with systemic lupus erythematosus and vasculitis.
The Director of the Chronic Kidney Disease (CKD) programme is Dr Kwek Jia Liang. The CKD program aims to optimise care delivery between primary care and institutional CKD practices as well as focus on certain care areas such as obstetric nephrology.
The lead for the Chronic Kidney Disease Mineral Bone Disease (CKD MBD) programme is Dr Wong Jiunn. The CKD MBD provides expert consultative care for patients with complex mineral bone disease issues not uncommon in patients with end stage kidney failure.
The Director of the Haemodialysis (HD) service and centre is Dr Sheryl Gan. The HD service provides haemodialysis for patients with end stage kidney failure who are admitted to hospital, evaluate and manage patients with complications from haemodialysis including complex conditions such as malnutrition and pregnancy. Secondly, the HD service also manages patients with acute kidney failure requiring temporary acute haemodialysis or continuous kidney replacement therapy. In addition, we are able to provide charcoal haemoperfusion and plasma exchange for patients with poisoning and severe autoimmune conditions respectively. To deliver these comprehensive services, our HD service operates two dialysis centres, comprising of a total of 30 in-center haemodialysis stations as well as mobile dialysis units to provide round the clock support to the entire Outram campus.
The Director of the Peritoneal Dialysis (PD) Programme and centre is Assoc Prof Marjorie Foo. The PD program provides training and education for patients with end stage kidney failure accepted into the PD programme and is the regional referral centre for training in both Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD). PD prescriptions are personalised to suite patient’s lifestyle. Modified dialysis regimens are also performed in PD centre e.g. intermittent PD. The centre also has dialysate preparation that are biocompatible e.g. icodextrin-based to cater for specific needs. The program offers cloud-based treatment monitoring for APD. The provision of a 24Hr clinical hotline enable patients on home based treatment to have access queries that might arise at home. The PD center offers a seamless program for modality transfer as well as personalised care exploring patient related outcomes measures (PROMS) for holistic and quality treatment.
The Director of the Critical Care Nephrology service is Dr Manish Kaushik. The Critical Care Nephrology service provides acute extra-corporeal blood purification services, for critically ill patients with acute kidney injury admitted to the Intensive Care Units, High Dependency Units or Intermediate Care Areas.
The Director of Renal Transplantation is Clinical Assoc Prof Terence Kee. Established in 1970, the renal transplantation programme is manned by a multidisciplinary team of physicians, surgeons, nurses and allied health care providers to offer a holistic, patient centric and comprehensive range of services to those seeking or undergone kidney transplantation and kidney donation. These services include evaluation of potential kidney failure patients and living kidney donors for kidney transplantation and donation as well as performing all types of adult kidney transplantation including ABO and HLA incompatible/Positive Crossmatch kidney transplants. The program also provides long-term follow-up care of patients who have undergone kidney transplantation and donation. The renal transplant programme also has an active outreach program to educate patients and the community about kidney donation and transplantation. As part of an Academic Centre, the renal transplant program has an active research programme and collaborates with international academic programs elsewhere to improve the care of kidney transplant recipients and donors.
The Director of the Interventional Nephrology programme is Dr Tan Ru Yu. The Interventional Nephrology program provides a comprehensive service for the management of end stage kidney disease patients with vascular access dysfunction. The interventional nephrology suites are fully equipped with both fluoroscopy and ultrasound equipment to provide a broad range of endovascular intervention capabilities.
The Department is also supported by the Transplant Coordinator Unit, Renal Coordinator Unit and the Renal Laboratory.
Transplant Coordinator Unit
The Transplant Coordinator Unit provides frontline care coordination for kidney transplant recipients and candidates. It also coordinates follow-up of living kidney donors. Transplant coordinators are also involved in educational and outreach activities to improve awareness of kidney donation and transplantation as well as empower patients to care for themselves after kidney transplantation or donation. The managers in charge of the transplant coordinator unit are Ms Tee Ping Sing (Operations) and Ms Yong Jin Hua (Quality, Education and Research).
Renal Coordinator Unit
The Renal Coordinator Unit provides important patient education to patients with chronic kidney disease including self-care techniques and kidney retardation principles. The unit is also integral in maintaining the kidney disease registry within the department in an effort to track, pinpoint deficiencies and optimise patient care. In addition to dialysis counselling, the coordinators also assist with application for subsidized dialysis and provides case management for patients with advanced stage kidney disease. The manager in charge of the Renal Coordinator Unit is Ms Lydia Lim Wei Wei.
The Renal Laboratory provides clinical support for the performance and processing of kidney tissues for biopsy and histopathology. In addition, the laboratory performs studies on urine immunoelectrophoresis to aid in the management of glomerular diseases. Research in immunochemistry, immunology in glomerular disease and transplantation, and molecular biology and genetics of kidney disorders is supported by the laboratory. The Director of Research is Dr Cynthia Lim who is also in charge of the Renal Laboratory.