Nephrology

Nephrology

Introduction

In the early 1950s, organ-centered specialties such as Nephrology began to develop in Europe. It wasn't until more than a decade later that such advancements reached this country. In 1962, a surgeon, Mr. G.A. Sreenivasan, returned from overseas training and took an interest in developing Urology as a specialty, along with a focus on haemodialysis.

In 1964, Mr. Sreeni, as he was popularly known, persuaded the Ministry of Health to acquire a Kolff Dialysis machine, which was placed in General Hospital Kuala Lumpur. Initially, the machine was solely used for treating acute renal failure, with 85 haemodialysis procedures performed between 1964 and 1968. Peritoneal dialysis was introduced by Dr. Sreeni in late 1966, also for the treatment of acute renal failure.

The Haemodialysis Unit began temporarily in Ward 4 in 1969 before relocating to its current building in 1970. The first long-term haemodialysis patient accepted was Mohamad Sabawi, who survived for over three and a half years. Initially, administratively, the Haemodialysis Unit and the renal replacement therapy program fell under the Department of Urology. However, it wasn't until 1975 that a nephrologist, Dr. Abu Bakar bin Dato' Suleiman (now Tan Sri Dato' Dr. Abu Bakar), took over and reorganized the dialysis unit, including treatment schedules and various aspects of the haemodialysis program.

In 1976, the Nephrology Unit was upgraded to a full department, signaling the start of programmed and integrated renal replacement therapy development in the country.

Haemodialysis - The Early Years

Chronic haemodialysis commenced in 1969, utilizing a homemade tank system for dialysate preparation and six dialysis machines employing Kill dialysers. Vascular access primarily involved arteriovenous shunts, which often experienced clotting. The Brescio-Cimino fistula for vascular access was only introduced in January 1977 by Dr. Proehoman, a consultant urologist.

A semi-automatic central delivery system, the Biosystem Mark 300, was installed in 1973 for six additional beds. Machines with single proportioning systems were acquired from 1975 onwards. Hollow fiber dialyses were introduced in the late 1970s, replacing the Kill and Maltec dialysers used previously.

A significant development occurred in 1980 with the installation of a Reverse Osmosis water treatment system. The unit expanded in 1977 and again in 1982 by adding ten beds.

A Home Dialysis Programme was introduced in 1978 due to increasing demand. Patients underwent training at HKL for three months in all aspects of haemodialysis.

Renal Transplantation

The first renal transplantation (living related) in Malaysia was performed by Dr. Hussein Awang, a consultant urologist, in 1975. Since then, nearly 829 transplants have been completed, with all but 108 from living related donors. The first cadaver renal transplantation occurred in 1976. The cadaveric program has gained momentum after campaigns targeting doctors and the public, resulting in approximately 20 yearly cadaveric renal transplants since 2000.

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Introduced in 1984, CAPD initially had ten selected patients, gradually increasing over the years. Presently, there are 746 patients on this therapy.

Clinical Services

The Department provides comprehensive clinical services, including:

- In-patient acute dialysis
- Evaluation of patients with renal diseases
- Renal transplantation
- Management of patients with end-stage renal disease
- Outpatient clinics

Inpatient Services

The department manages various renal disorders in the wards, including acute and chronic renal failure, glomerulonephritis, tubulointerstitial diseases, urinary tract infections, obstructive uropathy, and related disorders. It also performs interventional procedures such as renal biopsies and central venous catheterization, along with various dialysis modalities.

Acute Dialysis

Renal failure patients requiring dialysis, whether referred or admitted, are treated with intermittent haemodialysis, peritoneal dialysis, or continuous renal replacement therapy.

End-stage Renal Failure Programme

Hospital-based haemodialysis and home peritoneal dialysis, specifically CAPD, are offered. The haemodialysis center comprises three units with 36 stations, serving over 164 patients. The CAPD center, located between UN 2A & UN2B wards, caters to over 200 patients who dialyze at home.

Renal Transplantation

The renal transplant programme primarily involves living related donors, with cadaveric donations slowly gaining traction. Approximately 30-40 transplants are performed annually.

Renal Biopsy Service

Elective biopsies are conducted on specific weekdays, with urgent biopsies performed as needed.

Ancillary Services

Specialist dietitian, social worker, and pharmacist services are available.

Contact Information

Tel: 603 - 2615 5380
Fax: 603 - 2693 8953

Email: nefro@hkl.gov.my