The changing pattern of primary glomerulonephritis in Singapore and other countries over the past 3 decades.

This review of 2,586 renal biopsies over the past 3 decades in Singapore documents the changing pattern of glomerulonephritis (GN) from that of a third world country to that of a developed nation. In the 1st decade, mesangial proliferative glomerulonephritis was the most common form of primary GN, just as it was in the surrounding Asian countries. In the 2nd decade, the prevalence of mesangial proliferative GN decreased with a rise in membranous, GN which is also seen in China and Thailand. In the 3rd decade, there was a dramatic increase in focal sclerosing glomerulosclerosis. This increase reflects aging and obesity in keeping with more developed countries like Australia, India, Thailand and the United States of America. IgA nephritis remains the most common GN. Apart from the geographical influence, other socioeconomic factors play a significant role in the evolution of the renal biopsy pattern. Mesangial proliferative GN remains prevalent in many Asian countries, but in Singapore the prevalence is decreasing just as it is in Japan, Korea and Malaysia. Worldwide, the prevalence of focal sclerosing glomerulosclerosis continues to increase in many countries.

Beneficial effects of high-dose losartan in IgA nephritis.

AIM: Several short-term studies have reported the efficacy of high-dose ARB in reducing proteinuria in patients with diabetic nephropathy. The benefits of long-term high-dose ARB losartan in IgA nephritis have not been explored. METHOD: This was a 6-year randomized trial in 207 patients with IgA nephritis comparing high-dose ARB (losartan 200 mg/day) with normal dose ARB (losartan 100 mg/day), normal dose ACEI (20 mg/day) and low-dose ACEI (10 mg/day). Multivariate ANOVA was used to test the effect of drug treatment on both eGFR and total urinary protein (TUP). RESULTS: Comparing patients on high-dose ARB (n = 63) with those on normal dose ARB (n = 43), normal dose ACEI (n = 61) and low-dose ACEI (n = 40), patients on high Dose ARB had significantly higher eGFR (p < 0.0005) and lower proteinuria (p < 0.005) at the end of the study. The loss in eGFR was 0.7 ml/min/year for high-dose ARB compared to 3.2 - 3.5 ml/ min/year for the other 3 groups (p = 0.0005). There were more patients on high-dose ARB with improvement in eGFR compared to other 3 groups (p < 0.001). CONCLUSION: Data from this study suggest that high-dose ARB therapy is more efficacious in reducing proteinuria and preserving renal function when compared with normal dose ARB and ACEI. In Year 5, patients on high-dose ARB had a gain in eGFR suggesting that there is possibility of recovery of renal function in these patients on long-term high-dose therapy.

A study on early onset peritonitis in CAPD patients.

OBJECTIVE: To study the incidence of peritonitis in CAPD patients in their first six months on CAPD. PATIENTS AND METHODS: All patients who started on CAPD between 1 January 1999 and 31 December 1999 were included in the study. All of them were followed for six months for development of peritonitis. RESULTS: Four episodes of CAPD related peritonitis occurred in four different patients during this period. Patient One was an elderly man with diabetes mellitus who had Streptococcal peritonitis two months after he started on CAPD. Patient Two was an elderly woman with diabetes who developed Streptococcal peritonitis four months after she was on CAPD. Patient Three was a 51-year-old lady with diabetes who suffered Pseudomonas peritonitis at four months on CAPD. Patient Four was a young man without diabetes. He had peritonitis after he was on CAPD for four months. The culture showed no bacteria growth. For the first six months of CAPD the peritonitis rate was calculated as one episode for every 51 patient months. The average peritonitis rate of all patients on CAPD at the National University Hospital in 1999 was calculated as one episode for every 27 patient months. The CAPD related peritonitis involving new CAPD patients was lower.

Acute interstitial nephritis in Singapore: a report of five cases.

Interstitial nephritis is an uncommon cause of acute renal failure. Reported incidence varies widely in the literature and may depend on several factors i.e. geographical location, diagnostic criteria, dietary, environmental factors and therapeutic practices. This is a retrospective study of biopsy proven interstitial nephritis in National University Hospital Singapore. We report five cases out of a total of 349 biopsies carried out during a five-year period between September 1997 and August 2002. Four patients presented acutely with fever and or cough. In four patients, there was exposure to traditional Chinese medications and/or drugs. Renal failure in four out of the five patients progressed rapidly, three of whom required dialysis. One patient was treated with steroids. Renal function recovered in all patients with one patient who had significant residual renal impairment after one month.

Profile of admissions to an acute dialysis care unit.

The profile of admissions to an acute dialysis care facility of the National University Hospital Renal Centre, Singapore was studied in an attempt to identify the needs of these patients so that admissions may be possibly reduced. All patients above the age of 18 years who were admitted to the dialysis centre in the National University Hospital for dialysis between 1 Jan 2000 and 31 Mar 2000 inclusive were studied. A total of 124 patients were studied. Almost all the patients had end stage renal failure. The commonest cause of end stage renal failure was diabetic nephropathy (58.8%). There were a total of 157 admissions. Most of the admissions were associated with end stage renal failure (96%). Vascular access problems caused 40% of all admissions and 68% of all multiple admissions. The data suggest that a dialysis facility in a multidisciplinary acute hospital needs to meet the requirements of mainly patients who are already in end stage renal failure, those who have vascular access problems and those who have diabetes.