The history of dialysis in Singapore.

The last 20 years has been seen the birth of nephrology in Singapore, starting from a single machine in a side room of a ward to a fully fledged unit with a satellite centre. Renal transplantation and hemodialysis have been accepted as a form of therapy for renal failure in Singapore. The spin off from the creation of dialysis units has been improvement in overall renal care particularly in cases of acute renal failure. It has also generated an atmosphere for research into renal diseases and has helped to promote the image of Singapore as a medical centre par excellence in Southeast Asia.

Nephrotic syndrome associated with malignant tumours.

The nephrotic syndrome complicating malignancy is an unusual occurrence. We report here four cases of nephrotic syndrome associated with malignant tumours. Three cases were associated with bronchogenic carcinoma and one with adenocarcinoma of colon. One of the four cases developed nephrotic syndrome before the discovery of bronchogenic carcinoma. All patients had renal biopsies with light microscopy, immunofluorescence and electron microscopy. The findings suggest an immune-complex disease complicating malignancy. The true incidence of nephrotic syndrome associated with malignant tumours is unknown. However it is clinically prudent to screen for malignancy in older patients presenting with nephrotic syndrome.

Allopurinol associated hypersensitivity reactions: cutaneous and renal manifestations.

Five patients developed fever, "toxaemia", severe skin reactions and eosinophilia, three to six weeks after commencing allopurinol therapy. The presenting feature in these patients was an extensive erythema, progressing to an exfoliative dermatitis, sometimes with oral mucous membrane involvement. One patient developed toxic epidermal necrolysis. The clinical course in two patients was complicated by acute renal failure which necessitated dialysis. The clinical and laboratory features support an acute hypersensitivity mechanism in these allopurinol associated reactions, in agreement with previous studies. Patients with chronic renal failure appear particularly prone to severe, potentially fatal reactions. If these patients need allopurinol, a lower dose than would be normally required should be given.