Friday, January 29, 2010
Thursday, December 24, 2009
Dr Chow Yok Wai MRCP (UK) - Curriculum Vitae
Curriculum Vitae- Dr Chow Yok Wai
Education
Basic Medical Qualification
University Attended: University of Science Malaysia
Degree Obtained: Doctor of Medicine (MD)
Date Awarded: 25th July 1999
MRCP (Member of the Royal College of Physicians)
Date Awarded: 22nd July 2003
Working Experience
July 1999-October 2000
• Commenced internship training in Sultanah Aminah Hospital Johor Bahru
(HSAJB), Malaysia
• Underwent 18 months training in General Medicine, General Surgery
(Including Plastic Surgery, Urology, Neurosurgery and Paediatric Surgery),
Obstetrics and Gynaecology, Orthopaedics and General Paediatrics.
November 2000-March 2001
• Joined the Department of Medicine HSAJB as a medical officer
• Commenced subspeciality rotation in Nephrology
April 2001-October 2001
• Haematology rotation
November 2001-March 2002
• Neurology rotation
April 2002-November 2002
• Infectious Disease and Intensive Medicine rotation
December 2002-July 2003
• Cardiology, Respiratory Medicine, Gastroenterology and Endocrinology
rotation
July 2003-December 2004
• Granted membership to the Royal College of Physicians of United Kingdom
• Assigned to a 35 bedded general medical ward as general physician in
Sultanah Aminah Hospital Johor Bahru, Malaysia upon completion of MRCP
January 2005-June 2006
• Commencement of Nephrology Subspeciality Training
(Nephrology Followship Programme) in HSAJB
July 2006-December 2007
• Completion of Nephrology Subspeciality Training in Kuala Lumpur
Hospital, Malaysia
January 2008- April 2010
• Attached to the Nephrology Unit, Department of Medicine, HSAJB as
Consultant Nephrologist and Physician.
Post MRCP Training
(July 2003-December 2004)
Sultanah Aminah Hospital Johor Bahru, Malaysia
• Was assigned to a 35 bedded general medical ward upon completion of MRCP
• Below were the duties performed during the 18 month period:-
o Procedures:-
• Intubation and management of patient on ventilator support
• Ultrasonography of the abdomen
• Echocardiography
• Central venous pressure line insertion
• Pericardiocentesis
• Temporary pacemaker insertion
• Bone marrow aspiration
• Peritoneal dialysis
• Liver biopsy
• Chest tube insertion and pleural biopsy
• Exercise stress test
o Participation in CME activities:-
• Attends weekly hospital CMEs
• Attends and participates in monthly Malaysian Medical Association
joint meetings
• Conducts weekly house officer tutorials (Internal medicine)
• Co-chairs weekly departmental mortality meeting
o Participation in clinic duties:-
• Medical outpatient clinic (MOPC)- three times a week
• Diabetic clinic- every Monday
• Combine clinic with Obstetrics and Gynaecology Department (fetomaternal
and preconception clinic)- once a month
o Other duties:-
• On-call duty- General Medical call (4 times a month)
Nephrology Subspeciality Fellowship Training
(1/1/2005-30/6/2006)
Sultanah Aminah Johor Bahru, Malaysia
Sultanah Aminah Hospital Johor Bahru (HSAJB) is the largest General Hospital in Malaysia after Kuala Lumpur Hospital. It has 1000 beds and is the tertiary referral centre for the state of Johor with a population of 2.2 million. The Nephrology Unit is part of Department of Medicine with 2 consultant nephrologist.
The Nephrology Unit admits acute patients daily. Number of in-patients averages 50 per day. This include acute referrals from various intensive care units(ICU)- General ICU, Coronary Care Unit, Labour Room ICU, Cardiothoracic ICU, Medical High Dependency Unit and Neurosurgical High Dependency Unit numbering approximately 10 patients. There is an Invasive Cardiology Laboratory with Cardiology and Cardiothoracic Units. There is also an active Urology Unit.
The nephrology consultants does formal wards rounds on Tuesday and Fridays although there is a daily business round. The physicians working in the nephrology unit performs General Medical “active call” about 4 times each month. This is a 24 hour call involving acute general medical patients admitted into the medical unit from Outpatient Clinic and Emergency Department. In addition, there is also a business round being performed on every weekend and during public holidays (calls shared by nephrology trainee and consultants).
Summary statistics of Nephrology Unit, Sultanah Aminah Hospital Johor Bahru, 2005
Treatment per million polulation 154
Haemodialysis
Total dialysis sessions 68,172
Patients
HSAJB 108
Haemodialysis sessions 15,712
Home HD 16
Satellite HD unit (9 units) 394
CAPD
Patients 221
Patient days 59,422
Renal Transplant
New patients 14
Total patients 223
Continuous Renal Replacement Therapy
Patients 32
Acute Haemodialysis
Patients 366
Dialysis sessions 1,661
Acute Peritoneal Dialysis (no of sessions) 1,483
Other statistics, 2008
Renal biopsy 92
Clinic (no of patient visits) 10,712
o Includes patients with Chronic Kidney Disease, Glomerulonephritis and
patients on Haemodialysis, Continuous Ambulatory Peritoneal Dialysis and
Renal Transplant.
• Participation of CME activities
• Attends and participate in weekly journal club
• Attends and particpate in monthly renal histopathology meetings with
the Department of Pathology
Nephrology Subspeciality Fellowship Training
(1/7/2006-31/12/2007)
Institute of Urology and Nephrology,
Kuala Lumpur Hospital, Malaysia
Kuala Lumpur Hospital or commonly known as HKL has 38 different departments and units. It is the largest hospital under the Ministry of Health of Malaysia and is considered to be one of the biggest in Asia. It is a government tertiary referral hospital with 81 wards, 2500 beds and 7,000 staff. The Department of Nephrology is housed in the Institute of Urology and Nephrology in HKL.
There are 5 consultant nephrologists and 6 nephrology trainees. There are 3 general nephrology wards with a total of 80 beds with a wide variety of renal disorders being managed which includes patients with acute and chronic renal failure, glomerulonephritis, tubulointerstial diseases, urinary tract infection and obstructive uropathy and other related disorders. There is also an interventional nephrology unit which performs Y-tec peritoneoscopic insertion (weekly), permanent dialysis cuff catheters (twice a week), temporary central venous dialysis catheters (daily), renal biopsy and ultrasonography of the vascular access.
There is a 7 bedded nephrology-urology ICU in our institute being co-managed by the anaesthetist, urologist and nephrologists. This includes 2 beds for renal transplants. HKL is the main renal tranplant centre in the country and it performs 35 renal transplants a year.
This department receives referrals (averages 15 a day) from various departments in the hospital including the National Heart Institute of Malaysia. Nephrology trainees undergo “active” nephrology calls at least 5 times a month. This is a 24 hour call involving acute nephrology patients admitted into the institute of nephrology.
Summary statistics of Department of Nephrology, Kuala Lumpur Hospital, 2007
Haemodialysis
Total dialysis sessions 20,840
Patients 164
CAPD (includes 15 patients on APD)
Patients 220
Patient days 57,400
Renal Transplant
New patients 55
Total patients 374
Continuous Renal Replacement Therapy
CVVH 150 patients
SLEDD 40 patients
Acute Haemodialysis
Patients 940
Dialysis sessions 8,300
Acute Peritoneal Dialysis (no of sessions) 1,150
• Participation of CME activities
• Attends and participates in weekly journal club
• Attends and participates in weekly nephrology CME for nephrology trainees
• Attends and participates in weekly urology-nephrology conference
• Conducts weekly nephrology CME for medical officers
• Attends and participates in monthly renal histopathology meetings with the Department of Pathology
• Conducts monthly nephrology CME for supporting staff
• Participation in clinic duties (patient visits a year)
o Renal transplant clinics 1,450
o General nephrology clinics 7,250
o Haemodialysis clinic 1,000
o CAPD clinic 750
o Pre-dialysis clinic 1,500
Summary of Nephrology Fellowship Training Log-book
Clinical Rotations :-
Basic Nephrology (1/1/2005-30/4/2005)
Supervisor: Dr Hooi Lai Seong
Consultant Nephrologist and Head of Medicine,
Nephrology Unit, Department of Medicine,
Sultanah Aminah Hospital, Johor Bahru, Malaysia
Patient care experience:-
Management of hypertensive emergencies
Management of acute renal failure
Management of acute renal failure in pregnancy
Management of complications of renal biopsy
Management of acute poisoning
Procedures performed:-
Insertion of stiff peritoneal catheter- 50
Renal biopsy- 60
Non cuffed internal jugular catheter- 30
Non cuffed subclavian catheter- 10
Non cuffed femoral catheter- 20
Urine phase contrast microscopy- 20
Peritoneal dialysis cycler (setting up)- 3
Haemodialysis (1/5/2005-30/8/2005)
Supervisor: Dr Hooi Lai Seong
Consultant Nephrologist and Head of Medicine,
Nephrology Unit, Department of Medicine,
Sultanah Aminah Hospital, Johor Bahru, Malaysia
Patient care experience:-
Preparing patient for parathyroidectomy
Management of hungry bone syndrome
Management of vascular access complications
Management of patients with vascular access problems
Procedures performed:-
Intermittent haemodialysis (setting up)- 2
Reprocessing of dialysers- 3
Haemodiafiltration (setting up)- 2
Plasmapheresis- 3
Ultrasonography of vascular access- 5
Fistulography (observed)- 2
Endoluminal brushing of cuffed catheter- 3
Cuffed catheter insertion (Internal jugular)- 20
Renal Transplantation
(1/9/2005-31/12/2005)
Supervisor: Dr Hooi Lai Seong
Consultant Nephrologist and Head of Medicine,
Nephrology Unit, Department of Medicine,
Sultanah Aminah Hospital, Johor Bahru, Malaysia
(1/7/2007-30/9/2007)
Supervisor: Dr Ghazali Ahmad
Consultant Nephrologist and Head of department,
Department of Nephrology,
Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
Patient care experience:-
Pre transplant evaluation for living related transplant
Immediate post transplant management
Coordination of cadaveric renal transplantation
Management of acute rejection
Management of severe infection in transplant recipient
Management of post transplant hepatitis
Management of severe post transplant hypertension
Management of post transplant erythrocytosis
Procedures:-
Renal transplantation(observed)- 2
Ultrasonography of renal graft- 5
Renal graft biopsy- 5
General Nephrology (1/7/2006-31/12/2006)
Supervisor: Dr Rusnawati Yahya
Dr Sunita Bhavandan
Consultant Nephrologist,
Department of Nephrology,
Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
Patient care experience:-
Management of refractory nephrosis
Management of rapidly progressive glomerulonephritis
Management of severe SLE (multiorgan involvement)
Procedures performed:-
Creation of arterio-venous fistula (observe)
Ambulatory blood pressure monitoring interpretation
Ultrasonography of the urinary system
Peritoneal dialysis
(1/1/2006-30/4/2006)
Supervisor: Dr Hooi Lai Seong
Consultant Nephrologist and Head of Medicine,
Nephrology Unit, Department of Medicine,
Sultanah Aminah Hospital, Johor Bahru, Malaysia
(1/10/2007-31/12/2007)
Supervisor: Dr Lily Mushahar
Consultant Nephrologist,
Department of Nephrology,
Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
Patient care experience:-
Management of CAPD peritonitis
Management of recurrent exit site infection
Management of peritoneal membrane failure
Procedures performed:-
Insertion of surgical tenckhoff catheter (observe)- 2
Measurement of PET and dialysis adequacy (observe)- 2
Peritoneoscopic insertion of tenckhoff catheter- 20
Shaving of external cuff of tenckhoff catheter- 3
Exposure of the external cuff of the tenckhoff catheter- 3
Consult
(1/1/2006-30/4/2006)
Supervisor: Dr Hooi Lai Seong
Consultant Nephrologist and Head of Medicine,
Nephrology Unit, Department of Medicine,
Sultanah Aminah Hospital, Johor Bahru, Malaysia
(1/4/2007-30/6/2007)
Supervisor: Dr Ravindran Visvanathan
Consultant Nephrologist,
Department of Nephrology,
Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
Patient care experience:-
Management of orthopaedic patients with renal disease
Management of surgical patients with renal disease
Management of patients with HIV and renal disease
Management of cardiac patients with renal disease
Management of patients with liver and renal disease
Management of patients with haematological disorder
Critical care nephrology (1/1/2007-31/3/2007):-
Supervisor: Dr Ravindran Visvanathan
Consultant Nephrologist,
Department of Nephrology,
Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
Patient care experience:-
Management of patients with multiorgan failure
Management of patients on continuous renal replacement therapy
Management of patients with ARF post cardiac surgery
Nutritional management of the critically ill
Procedures performed:-
Setting up of CRRT machine- 3
Registration as a Medical Practitioner
5th July 2000
• Full registration with the Malaysian Medical Council
12th November 2008
• Full registration with the General Medical Council of United Kingdom
Official Gazettement by the Government of Malaysia (Ministry of Health)
22nd January 2005
• Gazetted as a Internal Medicine specialist
1st January 2008
• Gazetted as a Nephrologist
Professional Activities
2003
Clinical attachment in the New Royal Infirmary of Edinburgh, Scotland
Department of Nephrology
Position: Visiting Registrar
Supervisor: Dr Robin Winnie
Consultant Nephrologist
New Royal Infirmary of Edinburgh
Edinburgh
2008
Attended the Malaysian Nephrology Board Examination on 9th May 2008
Conducted by the Nephrology Board Malaysia
(Malaysian Society of Nephrology, Ministry of Health Malaysia, Academy of
Medicine, Malaysia)
Obtained the highest marks in the 2008 cohort
2008-2009
Awarded a full scholarship by the Public Services Department of Malaysia to
pursue advance nephrology training in the field of vasculitis in Addenbrooke’s Hospital Cambridge University Hospitals NHS Foundation Trust
Position: Honorary Clinical Research Fellow
Supervisor: 1) Dr David Jayne
Director of Lupus and Vasculitis,
Addenbrooke’s Hospital
Cambridge University Hospitals NHS Foundation Trust
2) Professor Kenneth Smith
Cambridge Institute of Medical Research,
University of Cambridge,
United Kingdom.
2008- 2009
Coordinator for National Glomerulonephritis Registry, National Renal Registry
(Johor Bahru)
Professional Bodies
National
Member of the Malaysian Medical Association
Member of the Malaysian Society of Nephrology
Member of the Postgraduate Renal Society, Malaysia
International
Member of the Royal College of Physicians of Edinburgh
Member of the International Society of Nephrology
Member of the IgA International Network
Research Activities
Publications:-
Acute renal failure in the same hospital 10 years apart; A comparison of two prospective studies in Sultanah Aminah Hospital, Johor Bahru
Medical Journal of Malaysia Vol 62 No1 March 2007
Lactic acidosis in HIV patients receiving highly active antiretroviral therapy- the Johor Bahru experience
Medical Journal of Malaysia Vol 62 No 1 March 2007
Quality improvement in Department of Nephrology, Kuala Lumpur Hospital- an audit on clinical performance indicators
Journal of Quality Improvement Vol 10 No 2 2007
Rituximab in Behcet’s Disease
Submitted to Annals of Rheumatic Diseases for publication (May 2009)
Participation in clinical studies:-
National
HDP study- Hospitalisation rate among Dialysis Patients study (2007)
International
GIANT study- Greatest International Antibiotic Trial study (2006)
A randomized double blind placebo controlled multicenter study to evaluate the efficacy and safety of two doses of Ocrelizumab in patients with WHO or ISN Class III or IV nephritis due to systemic lupus erythematosus (2008)
A phase III multicentre, double blind, double dummy, randomized flexible dose comparative study of MCI-196 versus Simvastatin for the treatment of dyslipidaemia in subjects with chronic kidney disease on dialysis (2009)
Evaluation of chronic kidney disease patterns through the global information database (GRID) (2009)
Biologic therapies in neuro-behcet’s disease, an international collaborative case-series- neurobehcet study group, International Society of Behcet’s Disease (2009)
CHiC-TRIAD (Cambridge Hinxton Centre for Translational Research In Autoimmune Disease) (2008-2009)
MY-CYC (A randomised clinical trial of mycophenolate mofetil versus cyclophosphamide for remission induction in ANCA associated vasculitis) (2008-2009)
Abstracts:-
National
OUTCOME OF A COMMUNITY BASED HEALTH SCREENING PROGRAMME DURING THE PUBLIC AWARENESS CAMPAIGN ON KIDNEY CARE IN JOHOR BAHRU, MALAYSIA
Oral Presentation- 22nd MSN Annual Seminar in Nephrology
Prevention of Chronic Kidney Disease
MYCOPHENOLATE MOFETIL IN RELAPSING LUPUS NEPHRITIS
23rd Malaysian Society of Nephrology Annual Seminar
Johor Bahru, Malaysia
11-13th April 2007
MYCOPHENOLATE MOFETIL IN MEMBRANOUS NEPHROPATHY
23rd Malaysian Society of Nephrology Annual Seminar
Johor Bahru, Malaysia
11-13th April 2007
International
ACUTE RENAL FAILURE IN THE SAME HOSPITAL 10 YEARS APART;
A COMPARISON OF TWO PROSPECTIVE STUDIES IN SULTANAH AMINAH
HOSPITAL, JOHOR BAHRU, MALAYSIA
Poster Presentation- 3rd World Congress of Nephrology
Post Congress Satellite Symposium
Acute Renal Failure: From Bench to Bedside
1st -3rd July 2005
LACTIC ACIDOSIS IN HIV PATIENTS RECEIVING HIGHLY ACTIVE ANTIRETROVIRAL THERAPY- THE JOHOR BAHRU EXPERIENCE
Oral Presentation
14th IUSTI Asia Pacific International Conference- 27th to 30th July, 2006
ADULT POLYCYSTIC KIDNEY DISEASE IN PATIENTS ON DIALYSIS IN MALAYSIA
11th Asian Pacific Congress of Nephrology 2008
ELDERLY PATIENTS INITIATING DIALYSIS IN MALAYSIA
11th Asian Pacific Congress of Nephrology 2008
MALIGNANCY POST RENAL TRANSPLANTATION: A 25 YEAR EXPERIENCE
11th Asian Pacific Congress of Nephrology 2008
LATE ACUTE ANTIBODY MEDIATED REJECTION ASSOCIATED WITH CALCINEURIN INHIBITOR MINIMISATION
11th Asian Pacific Congress of Nephrology 2008
CASTLEMAN’S DISEASE OF THE KIDNEY IN PATIENT WITH SLE
11th Asian Pacific Congress of Nephrology 2008
CLINICAL BENEFITS OF ICODEXTRIN: A SINGLE CENTRE EXPERIENCE
11th Asian Pacific Congress of Nephrology 2008
‘SUDOKU’ INCREASES COGNITIVE FUNCTION IN HAEMODIALYSIS PATIENTS- A PROSPECTIVE PILOT STUDY (Awarded Best Abstract)
11th Asian Pacific Congress of Nephrology 2008
SHORT TERM INFECTIOUS COMPLICATIONS POST RENAL TRANSPLANT
11th Asian Pacific Congress of Nephrology 2008
Education
Basic Medical Qualification
University Attended: University of Science Malaysia
Degree Obtained: Doctor of Medicine (MD)
Date Awarded: 25th July 1999
MRCP (Member of the Royal College of Physicians)
Date Awarded: 22nd July 2003
Working Experience
July 1999-October 2000
• Commenced internship training in Sultanah Aminah Hospital Johor Bahru
(HSAJB), Malaysia
• Underwent 18 months training in General Medicine, General Surgery
(Including Plastic Surgery, Urology, Neurosurgery and Paediatric Surgery),
Obstetrics and Gynaecology, Orthopaedics and General Paediatrics.
November 2000-March 2001
• Joined the Department of Medicine HSAJB as a medical officer
• Commenced subspeciality rotation in Nephrology
April 2001-October 2001
• Haematology rotation
November 2001-March 2002
• Neurology rotation
April 2002-November 2002
• Infectious Disease and Intensive Medicine rotation
December 2002-July 2003
• Cardiology, Respiratory Medicine, Gastroenterology and Endocrinology
rotation
July 2003-December 2004
• Granted membership to the Royal College of Physicians of United Kingdom
• Assigned to a 35 bedded general medical ward as general physician in
Sultanah Aminah Hospital Johor Bahru, Malaysia upon completion of MRCP
January 2005-June 2006
• Commencement of Nephrology Subspeciality Training
(Nephrology Followship Programme) in HSAJB
July 2006-December 2007
• Completion of Nephrology Subspeciality Training in Kuala Lumpur
Hospital, Malaysia
January 2008- April 2010
• Attached to the Nephrology Unit, Department of Medicine, HSAJB as
Consultant Nephrologist and Physician.
Post MRCP Training
(July 2003-December 2004)
Sultanah Aminah Hospital Johor Bahru, Malaysia
• Was assigned to a 35 bedded general medical ward upon completion of MRCP
• Below were the duties performed during the 18 month period:-
o Procedures:-
• Intubation and management of patient on ventilator support
• Ultrasonography of the abdomen
• Echocardiography
• Central venous pressure line insertion
• Pericardiocentesis
• Temporary pacemaker insertion
• Bone marrow aspiration
• Peritoneal dialysis
• Liver biopsy
• Chest tube insertion and pleural biopsy
• Exercise stress test
o Participation in CME activities:-
• Attends weekly hospital CMEs
• Attends and participates in monthly Malaysian Medical Association
joint meetings
• Conducts weekly house officer tutorials (Internal medicine)
• Co-chairs weekly departmental mortality meeting
o Participation in clinic duties:-
• Medical outpatient clinic (MOPC)- three times a week
• Diabetic clinic- every Monday
• Combine clinic with Obstetrics and Gynaecology Department (fetomaternal
and preconception clinic)- once a month
o Other duties:-
• On-call duty- General Medical call (4 times a month)
Nephrology Subspeciality Fellowship Training
(1/1/2005-30/6/2006)
Sultanah Aminah Johor Bahru, Malaysia
Sultanah Aminah Hospital Johor Bahru (HSAJB) is the largest General Hospital in Malaysia after Kuala Lumpur Hospital. It has 1000 beds and is the tertiary referral centre for the state of Johor with a population of 2.2 million. The Nephrology Unit is part of Department of Medicine with 2 consultant nephrologist.
The Nephrology Unit admits acute patients daily. Number of in-patients averages 50 per day. This include acute referrals from various intensive care units(ICU)- General ICU, Coronary Care Unit, Labour Room ICU, Cardiothoracic ICU, Medical High Dependency Unit and Neurosurgical High Dependency Unit numbering approximately 10 patients. There is an Invasive Cardiology Laboratory with Cardiology and Cardiothoracic Units. There is also an active Urology Unit.
The nephrology consultants does formal wards rounds on Tuesday and Fridays although there is a daily business round. The physicians working in the nephrology unit performs General Medical “active call” about 4 times each month. This is a 24 hour call involving acute general medical patients admitted into the medical unit from Outpatient Clinic and Emergency Department. In addition, there is also a business round being performed on every weekend and during public holidays (calls shared by nephrology trainee and consultants).
Summary statistics of Nephrology Unit, Sultanah Aminah Hospital Johor Bahru, 2005
Treatment per million polulation 154
Haemodialysis
Total dialysis sessions 68,172
Patients
HSAJB 108
Haemodialysis sessions 15,712
Home HD 16
Satellite HD unit (9 units) 394
CAPD
Patients 221
Patient days 59,422
Renal Transplant
New patients 14
Total patients 223
Continuous Renal Replacement Therapy
Patients 32
Acute Haemodialysis
Patients 366
Dialysis sessions 1,661
Acute Peritoneal Dialysis (no of sessions) 1,483
Other statistics, 2008
Renal biopsy 92
Clinic (no of patient visits) 10,712
o Includes patients with Chronic Kidney Disease, Glomerulonephritis and
patients on Haemodialysis, Continuous Ambulatory Peritoneal Dialysis and
Renal Transplant.
• Participation of CME activities
• Attends and participate in weekly journal club
• Attends and particpate in monthly renal histopathology meetings with
the Department of Pathology
Nephrology Subspeciality Fellowship Training
(1/7/2006-31/12/2007)
Institute of Urology and Nephrology,
Kuala Lumpur Hospital, Malaysia
Kuala Lumpur Hospital or commonly known as HKL has 38 different departments and units. It is the largest hospital under the Ministry of Health of Malaysia and is considered to be one of the biggest in Asia. It is a government tertiary referral hospital with 81 wards, 2500 beds and 7,000 staff. The Department of Nephrology is housed in the Institute of Urology and Nephrology in HKL.
There are 5 consultant nephrologists and 6 nephrology trainees. There are 3 general nephrology wards with a total of 80 beds with a wide variety of renal disorders being managed which includes patients with acute and chronic renal failure, glomerulonephritis, tubulointerstial diseases, urinary tract infection and obstructive uropathy and other related disorders. There is also an interventional nephrology unit which performs Y-tec peritoneoscopic insertion (weekly), permanent dialysis cuff catheters (twice a week), temporary central venous dialysis catheters (daily), renal biopsy and ultrasonography of the vascular access.
There is a 7 bedded nephrology-urology ICU in our institute being co-managed by the anaesthetist, urologist and nephrologists. This includes 2 beds for renal transplants. HKL is the main renal tranplant centre in the country and it performs 35 renal transplants a year.
This department receives referrals (averages 15 a day) from various departments in the hospital including the National Heart Institute of Malaysia. Nephrology trainees undergo “active” nephrology calls at least 5 times a month. This is a 24 hour call involving acute nephrology patients admitted into the institute of nephrology.
Summary statistics of Department of Nephrology, Kuala Lumpur Hospital, 2007
Haemodialysis
Total dialysis sessions 20,840
Patients 164
CAPD (includes 15 patients on APD)
Patients 220
Patient days 57,400
Renal Transplant
New patients 55
Total patients 374
Continuous Renal Replacement Therapy
CVVH 150 patients
SLEDD 40 patients
Acute Haemodialysis
Patients 940
Dialysis sessions 8,300
Acute Peritoneal Dialysis (no of sessions) 1,150
• Participation of CME activities
• Attends and participates in weekly journal club
• Attends and participates in weekly nephrology CME for nephrology trainees
• Attends and participates in weekly urology-nephrology conference
• Conducts weekly nephrology CME for medical officers
• Attends and participates in monthly renal histopathology meetings with the Department of Pathology
• Conducts monthly nephrology CME for supporting staff
• Participation in clinic duties (patient visits a year)
o Renal transplant clinics 1,450
o General nephrology clinics 7,250
o Haemodialysis clinic 1,000
o CAPD clinic 750
o Pre-dialysis clinic 1,500
Summary of Nephrology Fellowship Training Log-book
Clinical Rotations :-
Basic Nephrology (1/1/2005-30/4/2005)
Supervisor: Dr Hooi Lai Seong
Consultant Nephrologist and Head of Medicine,
Nephrology Unit, Department of Medicine,
Sultanah Aminah Hospital, Johor Bahru, Malaysia
Patient care experience:-
Management of hypertensive emergencies
Management of acute renal failure
Management of acute renal failure in pregnancy
Management of complications of renal biopsy
Management of acute poisoning
Procedures performed:-
Insertion of stiff peritoneal catheter- 50
Renal biopsy- 60
Non cuffed internal jugular catheter- 30
Non cuffed subclavian catheter- 10
Non cuffed femoral catheter- 20
Urine phase contrast microscopy- 20
Peritoneal dialysis cycler (setting up)- 3
Haemodialysis (1/5/2005-30/8/2005)
Supervisor: Dr Hooi Lai Seong
Consultant Nephrologist and Head of Medicine,
Nephrology Unit, Department of Medicine,
Sultanah Aminah Hospital, Johor Bahru, Malaysia
Patient care experience:-
Preparing patient for parathyroidectomy
Management of hungry bone syndrome
Management of vascular access complications
Management of patients with vascular access problems
Procedures performed:-
Intermittent haemodialysis (setting up)- 2
Reprocessing of dialysers- 3
Haemodiafiltration (setting up)- 2
Plasmapheresis- 3
Ultrasonography of vascular access- 5
Fistulography (observed)- 2
Endoluminal brushing of cuffed catheter- 3
Cuffed catheter insertion (Internal jugular)- 20
Renal Transplantation
(1/9/2005-31/12/2005)
Supervisor: Dr Hooi Lai Seong
Consultant Nephrologist and Head of Medicine,
Nephrology Unit, Department of Medicine,
Sultanah Aminah Hospital, Johor Bahru, Malaysia
(1/7/2007-30/9/2007)
Supervisor: Dr Ghazali Ahmad
Consultant Nephrologist and Head of department,
Department of Nephrology,
Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
Patient care experience:-
Pre transplant evaluation for living related transplant
Immediate post transplant management
Coordination of cadaveric renal transplantation
Management of acute rejection
Management of severe infection in transplant recipient
Management of post transplant hepatitis
Management of severe post transplant hypertension
Management of post transplant erythrocytosis
Procedures:-
Renal transplantation(observed)- 2
Ultrasonography of renal graft- 5
Renal graft biopsy- 5
General Nephrology (1/7/2006-31/12/2006)
Supervisor: Dr Rusnawati Yahya
Dr Sunita Bhavandan
Consultant Nephrologist,
Department of Nephrology,
Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
Patient care experience:-
Management of refractory nephrosis
Management of rapidly progressive glomerulonephritis
Management of severe SLE (multiorgan involvement)
Procedures performed:-
Creation of arterio-venous fistula (observe)
Ambulatory blood pressure monitoring interpretation
Ultrasonography of the urinary system
Peritoneal dialysis
(1/1/2006-30/4/2006)
Supervisor: Dr Hooi Lai Seong
Consultant Nephrologist and Head of Medicine,
Nephrology Unit, Department of Medicine,
Sultanah Aminah Hospital, Johor Bahru, Malaysia
(1/10/2007-31/12/2007)
Supervisor: Dr Lily Mushahar
Consultant Nephrologist,
Department of Nephrology,
Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
Patient care experience:-
Management of CAPD peritonitis
Management of recurrent exit site infection
Management of peritoneal membrane failure
Procedures performed:-
Insertion of surgical tenckhoff catheter (observe)- 2
Measurement of PET and dialysis adequacy (observe)- 2
Peritoneoscopic insertion of tenckhoff catheter- 20
Shaving of external cuff of tenckhoff catheter- 3
Exposure of the external cuff of the tenckhoff catheter- 3
Consult
(1/1/2006-30/4/2006)
Supervisor: Dr Hooi Lai Seong
Consultant Nephrologist and Head of Medicine,
Nephrology Unit, Department of Medicine,
Sultanah Aminah Hospital, Johor Bahru, Malaysia
(1/4/2007-30/6/2007)
Supervisor: Dr Ravindran Visvanathan
Consultant Nephrologist,
Department of Nephrology,
Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
Patient care experience:-
Management of orthopaedic patients with renal disease
Management of surgical patients with renal disease
Management of patients with HIV and renal disease
Management of cardiac patients with renal disease
Management of patients with liver and renal disease
Management of patients with haematological disorder
Critical care nephrology (1/1/2007-31/3/2007):-
Supervisor: Dr Ravindran Visvanathan
Consultant Nephrologist,
Department of Nephrology,
Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
Patient care experience:-
Management of patients with multiorgan failure
Management of patients on continuous renal replacement therapy
Management of patients with ARF post cardiac surgery
Nutritional management of the critically ill
Procedures performed:-
Setting up of CRRT machine- 3
Registration as a Medical Practitioner
5th July 2000
• Full registration with the Malaysian Medical Council
12th November 2008
• Full registration with the General Medical Council of United Kingdom
Official Gazettement by the Government of Malaysia (Ministry of Health)
22nd January 2005
• Gazetted as a Internal Medicine specialist
1st January 2008
• Gazetted as a Nephrologist
Professional Activities
2003
Clinical attachment in the New Royal Infirmary of Edinburgh, Scotland
Department of Nephrology
Position: Visiting Registrar
Supervisor: Dr Robin Winnie
Consultant Nephrologist
New Royal Infirmary of Edinburgh
Edinburgh
2008
Attended the Malaysian Nephrology Board Examination on 9th May 2008
Conducted by the Nephrology Board Malaysia
(Malaysian Society of Nephrology, Ministry of Health Malaysia, Academy of
Medicine, Malaysia)
Obtained the highest marks in the 2008 cohort
2008-2009
Awarded a full scholarship by the Public Services Department of Malaysia to
pursue advance nephrology training in the field of vasculitis in Addenbrooke’s Hospital Cambridge University Hospitals NHS Foundation Trust
Position: Honorary Clinical Research Fellow
Supervisor: 1) Dr David Jayne
Director of Lupus and Vasculitis,
Addenbrooke’s Hospital
Cambridge University Hospitals NHS Foundation Trust
2) Professor Kenneth Smith
Cambridge Institute of Medical Research,
University of Cambridge,
United Kingdom.
2008- 2009
Coordinator for National Glomerulonephritis Registry, National Renal Registry
(Johor Bahru)
Professional Bodies
National
Member of the Malaysian Medical Association
Member of the Malaysian Society of Nephrology
Member of the Postgraduate Renal Society, Malaysia
International
Member of the Royal College of Physicians of Edinburgh
Member of the International Society of Nephrology
Member of the IgA International Network
Research Activities
Publications:-
Acute renal failure in the same hospital 10 years apart; A comparison of two prospective studies in Sultanah Aminah Hospital, Johor Bahru
Medical Journal of Malaysia Vol 62 No1 March 2007
Lactic acidosis in HIV patients receiving highly active antiretroviral therapy- the Johor Bahru experience
Medical Journal of Malaysia Vol 62 No 1 March 2007
Quality improvement in Department of Nephrology, Kuala Lumpur Hospital- an audit on clinical performance indicators
Journal of Quality Improvement Vol 10 No 2 2007
Rituximab in Behcet’s Disease
Submitted to Annals of Rheumatic Diseases for publication (May 2009)
Participation in clinical studies:-
National
HDP study- Hospitalisation rate among Dialysis Patients study (2007)
International
GIANT study- Greatest International Antibiotic Trial study (2006)
A randomized double blind placebo controlled multicenter study to evaluate the efficacy and safety of two doses of Ocrelizumab in patients with WHO or ISN Class III or IV nephritis due to systemic lupus erythematosus (2008)
A phase III multicentre, double blind, double dummy, randomized flexible dose comparative study of MCI-196 versus Simvastatin for the treatment of dyslipidaemia in subjects with chronic kidney disease on dialysis (2009)
Evaluation of chronic kidney disease patterns through the global information database (GRID) (2009)
Biologic therapies in neuro-behcet’s disease, an international collaborative case-series- neurobehcet study group, International Society of Behcet’s Disease (2009)
CHiC-TRIAD (Cambridge Hinxton Centre for Translational Research In Autoimmune Disease) (2008-2009)
MY-CYC (A randomised clinical trial of mycophenolate mofetil versus cyclophosphamide for remission induction in ANCA associated vasculitis) (2008-2009)
Abstracts:-
National
OUTCOME OF A COMMUNITY BASED HEALTH SCREENING PROGRAMME DURING THE PUBLIC AWARENESS CAMPAIGN ON KIDNEY CARE IN JOHOR BAHRU, MALAYSIA
Oral Presentation- 22nd MSN Annual Seminar in Nephrology
Prevention of Chronic Kidney Disease
MYCOPHENOLATE MOFETIL IN RELAPSING LUPUS NEPHRITIS
23rd Malaysian Society of Nephrology Annual Seminar
Johor Bahru, Malaysia
11-13th April 2007
MYCOPHENOLATE MOFETIL IN MEMBRANOUS NEPHROPATHY
23rd Malaysian Society of Nephrology Annual Seminar
Johor Bahru, Malaysia
11-13th April 2007
International
ACUTE RENAL FAILURE IN THE SAME HOSPITAL 10 YEARS APART;
A COMPARISON OF TWO PROSPECTIVE STUDIES IN SULTANAH AMINAH
HOSPITAL, JOHOR BAHRU, MALAYSIA
Poster Presentation- 3rd World Congress of Nephrology
Post Congress Satellite Symposium
Acute Renal Failure: From Bench to Bedside
1st -3rd July 2005
LACTIC ACIDOSIS IN HIV PATIENTS RECEIVING HIGHLY ACTIVE ANTIRETROVIRAL THERAPY- THE JOHOR BAHRU EXPERIENCE
Oral Presentation
14th IUSTI Asia Pacific International Conference- 27th to 30th July, 2006
ADULT POLYCYSTIC KIDNEY DISEASE IN PATIENTS ON DIALYSIS IN MALAYSIA
11th Asian Pacific Congress of Nephrology 2008
ELDERLY PATIENTS INITIATING DIALYSIS IN MALAYSIA
11th Asian Pacific Congress of Nephrology 2008
MALIGNANCY POST RENAL TRANSPLANTATION: A 25 YEAR EXPERIENCE
11th Asian Pacific Congress of Nephrology 2008
LATE ACUTE ANTIBODY MEDIATED REJECTION ASSOCIATED WITH CALCINEURIN INHIBITOR MINIMISATION
11th Asian Pacific Congress of Nephrology 2008
CASTLEMAN’S DISEASE OF THE KIDNEY IN PATIENT WITH SLE
11th Asian Pacific Congress of Nephrology 2008
CLINICAL BENEFITS OF ICODEXTRIN: A SINGLE CENTRE EXPERIENCE
11th Asian Pacific Congress of Nephrology 2008
‘SUDOKU’ INCREASES COGNITIVE FUNCTION IN HAEMODIALYSIS PATIENTS- A PROSPECTIVE PILOT STUDY (Awarded Best Abstract)
11th Asian Pacific Congress of Nephrology 2008
SHORT TERM INFECTIOUS COMPLICATIONS POST RENAL TRANSPLANT
11th Asian Pacific Congress of Nephrology 2008
Thursday, October 1, 2009
Renal Biopsy
Renal Biopsy Patient Information Sheet
Kidney (renal) Biopsy
Introduction
This leaflet tells you about having a kidney biopsy. Please read it as well as talking to your doctor/nurse.
What is a kidney biopsy?
A kidney or renal biopsy means removing a very small sample (about half a matchstick in size) from one of your kidneys using a special needle. The sample can then be tested under a microscope to find out the cause of your kidney disease.
Why would you need to have a kidney biopsy?
You will know that blood or urine tests have shown that your kidneys are not working properly. A biopsy may find the cause of the kidney disease and tell what the best treatment is.
Where is it done?
The biopsy will usually be carried out in the ward,a special procedure room,the operating theatre or the X-ray department.It takes about thirty minutes and will usually be done under local anaesthesia and oral sedation. You will remain awake throughout the procedure.You can eat and drink normally before and after the biopsy is done.
How is it done?
You will usually be asked to lie face down on the bed or couch with a pillow under your stomach. Usually the exact position of the kidney will be found using an ultrasound machine. The skin on your back over the kidney will be cleaned with antiseptic and local anaesthetic will be injected into the skin. It may sting at first and once the skin is numb more local anaesthetic is injected around the kidney. The biopsy needle will then be passed through the numb area and the kidney sample taken. You will be asked to hold your breath for a few seconds as the kidney moves during breathing. You should usually not be aware of any pain from the biopsy needle but you may feel a little pressure and hear a clicking sound when the biopsy sample is taken. The doctor may ask to take two or three biopsy samples and occasionally it will not be possible to remove a suitable bit of the kidney.
What happens afterwards?
Afterwards you will be asked to rest in bed for at least six hours. Your pulse 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. When the local anaesthetic wears off you may feel some pain in the back due to slight bruising for which you can be given a mild painkiller.
A provisional result of the biopsy should be available within 24-48 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 that day or the following day to rest. After the biopsy you should avoid exercise for 48 hours and if you develop severe pain around the kidney or any blood in the urine you should contact the kidney unit straight away.
What are the risks of a kidney biopsy?
The risk of a serious complication is small. The main risk is that the biopsy needle can damage the kidney or other parts of the body nearby. Your doctor has recommended a kidney biopsy because it is felt that the information from the biopsy makes this small risk worthwhile and it is important that you agree about this.
Bleeding is the most serious complication. You will have a blood test before the biopsy to make sure your blood clots normally. It is important that you tell your doctor if you have any problem with easy bleeding or bruising or if you are taking tablets that can affect bleeding such as ASPIRIN, CLOPIDOGREL or WARFARIN. Normally these will need to be stopped several days before the procedure. You should also tell your doctor if you are allergic to antiseptic such as IODINE.
In about 1 in 10 biopsies there is visible bleeding in the urine that settles by itself.
In less than 1 in 50 biopsies there is more bleeding that requires a blood transfusion.
In less than 1 in 1500 biopsies the bleeding may continue and require urgent Xray tests or even an operation to stop the bleeding. In less than 1 in 3000 biopsies the kidney may have to be removed to stop the bleeding. Although deaths have occurred following complications of biopsies this is extremely rare.
What are the benefits of having a kidney biopsy?
A biopsy could help to find out what is wrong with your kidneys and decide about the correct treatment. It may avoid you being given unnecessary treatment which could have side effects and it may prevent further harm being done to your kidneys by being given the wrong treatment.
What are the alternatives to a kidney biopsy?
A biopsy is usually the last test to be done to work out what is wrong with your kidneys because the other tests have not provided the answer. Without a biopsy your doctor may not be able to advise the best treatment for you. Your doctor should be able to tell you what changes in treatment could be made for your kidneys if you decide not to have a biopsy taken first.
If you agree to have the biopsy you will be asked to sign the hospital’s consent form which will state that you have received information about the procedure and have discussed it with your doctor.
Kidney (renal) Biopsy
Introduction
This leaflet tells you about having a kidney biopsy. Please read it as well as talking to your doctor/nurse.
What is a kidney biopsy?
A kidney or renal biopsy means removing a very small sample (about half a matchstick in size) from one of your kidneys using a special needle. The sample can then be tested under a microscope to find out the cause of your kidney disease.
Why would you need to have a kidney biopsy?
You will know that blood or urine tests have shown that your kidneys are not working properly. A biopsy may find the cause of the kidney disease and tell what the best treatment is.
Where is it done?
The biopsy will usually be carried out in the ward,a special procedure room,the operating theatre or the X-ray department.It takes about thirty minutes and will usually be done under local anaesthesia and oral sedation. You will remain awake throughout the procedure.You can eat and drink normally before and after the biopsy is done.
How is it done?
You will usually be asked to lie face down on the bed or couch with a pillow under your stomach. Usually the exact position of the kidney will be found using an ultrasound machine. The skin on your back over the kidney will be cleaned with antiseptic and local anaesthetic will be injected into the skin. It may sting at first and once the skin is numb more local anaesthetic is injected around the kidney. The biopsy needle will then be passed through the numb area and the kidney sample taken. You will be asked to hold your breath for a few seconds as the kidney moves during breathing. You should usually not be aware of any pain from the biopsy needle but you may feel a little pressure and hear a clicking sound when the biopsy sample is taken. The doctor may ask to take two or three biopsy samples and occasionally it will not be possible to remove a suitable bit of the kidney.
What happens afterwards?
Afterwards you will be asked to rest in bed for at least six hours. Your pulse 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. When the local anaesthetic wears off you may feel some pain in the back due to slight bruising for which you can be given a mild painkiller.
A provisional result of the biopsy should be available within 24-48 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 that day or the following day to rest. After the biopsy you should avoid exercise for 48 hours and if you develop severe pain around the kidney or any blood in the urine you should contact the kidney unit straight away.
What are the risks of a kidney biopsy?
The risk of a serious complication is small. The main risk is that the biopsy needle can damage the kidney or other parts of the body nearby. Your doctor has recommended a kidney biopsy because it is felt that the information from the biopsy makes this small risk worthwhile and it is important that you agree about this.
Bleeding is the most serious complication. You will have a blood test before the biopsy to make sure your blood clots normally. It is important that you tell your doctor if you have any problem with easy bleeding or bruising or if you are taking tablets that can affect bleeding such as ASPIRIN, CLOPIDOGREL or WARFARIN. Normally these will need to be stopped several days before the procedure. You should also tell your doctor if you are allergic to antiseptic such as IODINE.
In about 1 in 10 biopsies there is visible bleeding in the urine that settles by itself.
In less than 1 in 50 biopsies there is more bleeding that requires a blood transfusion.
In less than 1 in 1500 biopsies the bleeding may continue and require urgent Xray tests or even an operation to stop the bleeding. In less than 1 in 3000 biopsies the kidney may have to be removed to stop the bleeding. Although deaths have occurred following complications of biopsies this is extremely rare.
What are the benefits of having a kidney biopsy?
A biopsy could help to find out what is wrong with your kidneys and decide about the correct treatment. It may avoid you being given unnecessary treatment which could have side effects and it may prevent further harm being done to your kidneys by being given the wrong treatment.
What are the alternatives to a kidney biopsy?
A biopsy is usually the last test to be done to work out what is wrong with your kidneys because the other tests have not provided the answer. Without a biopsy your doctor may not be able to advise the best treatment for you. Your doctor should be able to tell you what changes in treatment could be made for your kidneys if you decide not to have a biopsy taken first.
If you agree to have the biopsy you will be asked to sign the hospital’s consent form which will state that you have received information about the procedure and have discussed it with your doctor.
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