Specialist Consult

Arrange to meet our kidney specialist face-to-face, so that they can take a detailed history and perform a physical examination, and assess the clinical symptoms or abnormal investigation results you may have. Our specialist will address all your concerns and provide you will a clear and detailed explanation about your condition, and propose a diagnostic evaluation and treatment plan, based on the latest clinical evidence and information, as an overall solution to your health issues.

Kidney Symptoms

Unfortunately, most kidney diseases do not present with symptoms until there is leakage of massive amount of protein in the urine or when the kidney function is significantly damaged. Most often, kidney diseases are uncovered when abnormal blood or urine test results are obtained during health screening.

Kidney Conditions

The following provide you with some basic information on common kidney conditions. They are not meant to substitute a consult with your kidney specialist, but to provide some background understanding of the respective kidney disease.

Kidney Biopsy

What is a Kidney Biopsy?

• A kidney biopsy involves obtaining 2-3 very small samples, each about 1 cm in length, from one of your kidneys using a special needle.
• The samples can then be processed and tested under the microscope to find out the cause of your kidney disease, how active the disease is or how much scarring there are in the kidneys.

Why do I need this procedure?

• Although many kidney problems can be diagnosed from your symptoms, physical examination, blood tests and scans, there are others for which direct examination of your kidney tissue is essential to make a precise diagnosis and plan treatment.
• Examples include unexplained protein or blood in the urine, swelling in your legs or other parts of the body due to excessive protein leakage in the kidneys, un explained poor kidney function or kidney failure or an assessment of kidney damage in conditions such as systemic lupus erythematosus (SLE).
• The pathologist reading your biopsy samples will be able to tell if there is inflammation of the filters in the kidneys, which is called glomerulonephritis, or other forms of damage that can account for the kidney problem.
• Your kidney specialist will only request a kidney biopsy if it is necessary to help make the correct diagnosis and plan your treatment. He or she will tell you what is being looked for and answer any questions you may have about the procedure.

What are the preparations before the biopsy?

• A simple blood test to check your clotting ability will be done before the procedure.
• If you are taking any blood thinning medication such as Aspirin, Ticlodipine or Clodiprogel, you will have to stop the medication at least 5 days before the procedure.
• There is no other preparation required on your part, and there is no need for you to omit food or drinks before the procedure.
• Please also continue to take your other medications, unless instructed by your kidney specialist.

How is the procedure performed?

• The biopsy is performed under ultrasound scan guidance.
• You will lie on your stomach and the ultrasound scan will be used to identify a point over one kidney for the biopsy.
• A small needed will be used to inject local anaesthetic into the skin, fat and muscle area above the kidneys, so that it will become numb and you will not feel any pain thereafter.
• Once the area is numb, the biopsy needle will be passed to your kidney and a small piece of kidney tissue will be obtained with the press of a button.
• Two to three pieces are usually needed, so as to obtain enough tissue for diagnosis.
• You will feel a pushing sensation but it should not be painful, and only one kidney is biopsied.
• A dressing will be applied and you will be asked to remain lying flat in bed, to allow your body to compress on the biopsy area, for about 8 hours.

What are the risks and complications of the procedure?

• In about 1 in 10 biopsies, there is visible bleeding in the urine that will usually settle spontaneously.
• In less than 1 in 50 biopsies, there is more bleeding that requires a blood transfusion.
• In less than 1 in 1,500 biopsies, the bleeding may continue and require urgent X-ray scans or even an operation to stop the bleeding.
• In less than 1 in 3,000 biopsies, the kidney may have to be removed to stop the bleeding.

What do I expect after the procedure?

• After the biopsy, you will be asked to rest in bed for at least 8 hours.
• Your pulse rate and blood pressure will be monitored and when you pass urine, it will be tested for bleeding.
• During this time, you can eat normally and will usually be encouraged to drink plenty of fluids, unless instructed by your kidney specialist not to do so.
• When the local anaesthetic wears off, you may feel some soreness over the back, for which you can be given a mild painkiller.
• A provisional result of the biopsy should be available within 48 hours, but the full report may take longer.
• If you feel well after the biopsy and have no pain or bleeding, you may be able to go home later the following day to rest.
• After the biopsy, you should avoid exercise and not carry heavy weights for 2 weeks.
• If you develop severe pain around the kidney or notice any blood in your urine, you should contact your kidney specialist straight away.

Is there any other option?

• A kidney biopsy is usually the last test to be done to investigate the cause of your kidney problem, because the other tests have not provided any better answer.
• Without a biopsy, your doctor may not be able to advise the best treatment for you, and the kidney damage may progress and become irreversible.

What will happen if I do not undergo the procedure?

• Your kidney specialist will tell you what changes in treatment could be made for your kidneys if you decide not to have a kidney biopsy taken first.
• He or she will also inform you of the risks of kidney damage and the potential outcomes.

Chronic Kidney Disease Management

Our specialist is a renowned expert in the management of diabetic kidney disease, the most common cause of kidney failure in Singapore, and have experience in successfully implementing chronic kidney disease management program. We have a structured program in screening for chronic kidney disease and implementing interventions to slow down the progression of kidney damage. You will be informed of the treatment goals, management plans and progress of your condition, with your care coordinated across other specialists and healthcare professionals where necessary.

What is Chronic Kidney Disease?

• Chronic kidney disease is the term used to describe a gradual loss of kidney function due to diseases affecting the kidneys.
• Often the damage to the kidneys is irreversible and as long as the diseases are present, the loss of kidney function will progress until advanced kidney failure occurs, where dialysis or kidney transplantation would be necessary to sustain life.
• The most common cause of chronic kidney disease in Singapore is diabetes mellitus and high blood pressure.
• Other causes include inflammation of the kidneys called glomerulonephritis, kidney stones, prolonged use of painkiller drugs or genetic diseases such as polycystic kidney diseases.

Screening for Chronic Kidney Disease

• People with conditions at high risks of kidney damage, such as diabetes or high blood pressure, should be screened for chronic kidney disease.
• Screening is usually done through blood and urine tests, looking for elevated toxins in the blood, and protein and/or blood in the urine.
• People with diabetes or high blood pressure should undergo screening at least annually, as interventions during the early stages of chronic kidney disease may slow down the progression or even prevent kidney failure.
• Screening for chronic kidney disease with similar blood and urine tests may be performed for the general population, though the cost-effectiveness of this had not been determined.

Slowing the Progression of Chronic Kidney Disease

• Your kidney specialist will control the risk factors that are associated with the progression of chronic kidney disease, including high blood pressure and uncontrolled blood sugar levels.
• Lifestyles modifications such as reducing the salt intake, smoking cessation, exercise and weight reduction have also been found to be effective in slowing the kidney damage. Your kidney specialist will review with you, the necessary treatment plan, so that these can be achieved in an effective and sustainable manner.
• Your kidney specialist may also start you on medications that have been shown to protect the kidneys. These drugs may be specific high blood pressure or diabetes medications, and often close monitoring for their effectiveness and possible effects are necessary.

Managing Complications of Chronic Kidney Disease

• As kidney disease progresses, complications could arise that may affect your quality of life and daily activities.
• These include anaemia, poor bone quality, skin itching, excess toxin accumulation and water retention.
• Your kidney specialist will screen for these complications early, often through specific blood investigations, and adjust your medications in a timely manner to ensure your comfort.

Kidney Transplantation

Kidney transplantation remains the best treatment for people with advanced kidney failure. However, not all patients are suitable for a transplant. Do discuss with your kidney specialist on the option of kidney transplantation, and how best to proceed with a kidney transplantation should you be considered suitable for this treatment.

What is Kidney Transplantation?

• Kidney transplantation involves the removal of a health kidney from a donor and surgically implant it into a patient with kidney failure.
• Because the new kidney is an organ foreign to the kidney transplant recipient, the patient will need to take medication to suppress the immune system from rejecting the transplanted kidney.

Suitability for a kidney transplant

• Kidney transplantation is the best treatment option for patients with advanced kidney failure, and anyone who is suitable should receive a kidney transplantation when possible.
• However, not all patients are suitable for a kidney transplant. Your kidney specialist will assess the safety of you undergoing general anaesthesia and the surgical procedure of a transplant, depending on your overall health and medical conditions.
• In addition, as medications are required to suppress your immune system, your kidney specialist will also need to assess you for risks of infections and cancer, that may flare up when your immune system becomes weakened.

Assessing the kidney donor

• The best outcomes for a kidney transplant occur with a living donor, especially if the donor is related to the patient.
• Likewise, the kidney specialist will need to ensure that the donor is healthy and it is safe for him or her to undergo general anaesthesia and to have the surgery to remove one kidney.
• In addition, the kidney specialist will also have to determine that the risk of the donor developing kidney failure after the transplant or in the future, is low enough for him or her to donate a kidney.
• Your donor will also be screened for infections and unknown cancers that could potentially be transmitted to the recipient during the transplantation.

Risks associated with a kidney transplant

• There are risks associated with general anaesthesia the actual surgical procedure. Bleeding, infection and damage to surrounding structures are risks associated with any surgical procedure. Your kidney specialist will arrange for you to have an in-depth discussion with the anaesthetist and transplant surgeon before the actual procedure.
• As drugs are required to suppress your immune system, you will be at a higher risk for infections and cancers. Your kidney specialist will start you on medications that may protect you from certain infections, and arrange for you to undergo cancer screening regularly.
• There is always a risk that the new kidney may not work despite all measures to maximize the outcome before, during and after the transplant.
• Despite the medications to suppress your immune system, your body may continue to reject the transplanted kidney. When a rejection occurs, your kidney specialist will attempt to salvage the kidney with medications or specialized treatment. However, sometimes a rejection is severe enough that the kidney will stop functioning and you will need to go back on dialysis.