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Renal Medicine

Renal Medicine at Sengkang General Hospital is a dynamic department catering to the needs of population of north east of Singapore comprising of around one million people. It offers 24/7 service for all the common emergency kidney related medical conditions needing inpatient treatment. In addition, the specialist outpatient clinics with the various sub speciality renal services offer excellent outpatient care. The dedicated multidisciplinary team comprises of a wide range of experienced renal doctors, nurses, pharmacists, dieticians, renal coordinators (RC) and medical social workers (MSW). The department is ably supported by vascular surgeons and interventional radiologists providing high quality and efficient vascular access service required for all dialysis patients.

The specialists in the team are highly experienced and have varied background. An empathetic, customised and holistic care is offered to patients, actively involving them and their caregivers in the decision making. The treatment is tailored to the needs of the individual patients based on their choices and preferences. There is huge emphasis on patient safety and quality. It runs an efficient service aimed at optimal clinical outcome, enhanced patient experience and satisfaction.

The department has a modern, purpose-built Renal Dialysis Center (RDC) with 17 stations for patients needing haemodialysis support. Peritoneal dialysis training center (PDTC) located in the medical centre at level 7 offers peritoneal dialysis training and doubles up as a walk-in clinic for peritoneal dialysis patients with intercurrent problems. The renal specialists oversee the renal replacement therapy of critically ill patients admitted to the Intensive Care Units (ICUs) which includes continuous kidney replacement therapy (CKRT). Specialised extracorporeal treatment such as therapeutic plasma exchange is offered by the renal team in the high dependency unit. Procedures like kidney biopsy and tunnelled dialysis catheter insertion is carried out in the inpatient setting for patients admitted to renal/vascular and general medical wards.

In addition to the general nephrology clinic where patients with various different types of kidney disease such as diabetic kidney disease, hypertensive nephropathy, polycystic kidney disease, vasculitis, glomerulonephritis and electrolyte abnormalities are managed, renal department also offers subspeciality clinics which include low clearance clinic where patients approaching end stage kidney disease are seen by multidisciplinary team comprising of the nephrologist, RC and MSW. In addition, for elderly patients with significant medical conditions who opt for conservative (nondialytic) therapy, conservative care clinic is available which is run by a senior nephrologist with special interest in conservative care supported by RC and MSW.

The department has close links with the Department of Renal Medicine, Singapore General Hospital for treatments not available in-house, for example, kidney transplantation. In addition, there is also collaboration with them in the fields of education and research.

Our Clinical Services

  • Inpatient nephrology service
    • A dedicated renal ward for renal patients needing inpatient care. Renal care for the patients admitted in general medicine wards is closely supervised by renal specialists.
    • 17 station RDC for inpatient dialysis.
    • Inpatient peritoneal dialysis support.
    • Dialysis Access surgery/salvage service by vascular surgery department.
    • Interventional radiology service for renal patients needing vascular procedures.
    • Kidney biopsy performed either by nephrologists or interventional radiologists.
  • Critical Care Nephrology service
    • ICU/HDU facility for severely ill patients needing renal support.
    • Continuous renal replacement therapy in ICU supervised by renal specialists.
    • Therapeutic plasma exchange service provided by renal specialists in HDU
  • Outpatient Nephrology service
    • General nephrology clinics where all types of renal diseases from early to late stage are managed with special emphasis on preventing the progression of the kidney disease. In addition, hemodialysis and peritoneal dialysis patients, patients with difficult hypertension and electrolyte imbalances are managed in these clinics.
    • Walk in clinic for PD related problems (PDTC)
    • RC/clinic for CKD and dialysis education/ counselling
  • Low clearance service
    • Patients who are likely to need dialysis within the next one year are managed in this clinic by a multidisciplinary team comprising of nephrologist, RC and MSW.

The main aim of this clinic is adequate preparation of the patient for dialysis as the patients who initiate without adequate preparation tend to have poor outcome.

  • Transition care service
    • Patients newly initiated on hemodialysis are seen in these multidisciplinary clinics with nephrologist, RC and MSW.
    • In addition to the clinical care, psychosocial support and overall care coordination is provided with the aim to improve the patient outcome and reduce the risk of complications.
  • Conservative care service
    • People who decline dialysis for various reasons including advanced age and comorbidities are seen in these multidisciplinary clinics led by a nephrologist with special interest in conservative care.
    • In addition to the symptom control, coordination of their care in the community and advance care planning are the other main areas addressed in these patients.

Specialist investigations and treatments provided

Some of the renal treatments offered through our renal wards and outpatient clinics include:

  • Hemodialysis
  • Hemodiafiltration
  • CKRT
  • Peritoneal dialysis
  • Dialysis access creation and salvage
  • Immunosuppressive therapy
  • Therapeutic plasmapheresis
  • Kidney biopsy

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Conditions We Treat


  • Diabetic kidney disease
  • Difficult hypertension
  • Glomerulonephritis
  • Vasculitis
  • Interstitial nephritis
  • Adult polycystic kidney disease

 

Treatments Offered


FAQs

What is chronic kidney disease?

Your kidneys filter your blood and produce urine. Chronic kidney disease is a condition in which the kidneys undergo irreversible damage. It is a very common condition but if untreated it has the potential to progress to end stage kidney disease requiring dialysis or transplant.

Why did I get kidney disease?

Diabetes and high blood pressure are the two most common causes. Smoking and obesity are other risk factors. There are a number of other causes like genetic diseases, stone disease, inflammatory conditions affecting the kidneys and conditions that block urine flow. In a small minority, no cause can be found even after extensive investigation.

Can kidney disease be cured?

It depends on the type of kidney disease. Certain conditions affecting the kidneys can be effectively treated and kidney disease can be reversed. In those who develop chronic kidney disease due to whatever reason where the damage is permanent, progressive worsening can be avoided/delayed by good control of the risk factors and some dietary and lifestyle modifications. With these measures, end stage kidney disease can be prevented.

If a person requires dialysis treatment for kidney disease, is it always permanent?

Not necessarily. There are a number of causes for a condition called acute kidney injury where the kidneys stop working temporarily. Once the underlying problem is treated, kidneys often recover. Till they recover, kidneys may require support in the form of dialysis. But in the setting of worsening of chronic kidney disease leading to end stage kidney disease, if the patient requires dialysis, it is usually permanent unless the individual gets a kidney transplant.

Is dialysis the only option for kidney failure?

If the kidneys temporarily stop functioning, in addition to dialysis, the underlying condition needs to be treated. The treatment sometimes involves immunosuppressive therapy which can have some side effects. If the kidney failure is permanent, as in progression of chronic kidney disease to end stage kidney failure, depending on the age and medical conditions of the individual, treatment options include kidney transplant, dialysis or conservative management. Often elderly people with significant medical problems do not do very well on dialysis. In such individuals, evidence suggests that dialysis may not be very helpful and it may not prolong their life to a significant extent. Such patients, if they choose not to have dialysis, are managed conservatively with medications for symptom control.

 

Our Care Team

Sengkang General Hospital renal department offers a team of dedicated professionals including renal specialists, nurses, dieticians, pharmacists, RC and MSW to manage the whole spectrum of kidney disease in a timely manner. The department is equipped with most advanced and state of the art infrastructure to provide safe and effective care.

 

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