Kidney disease is on the rise globally, and I decided to dedicate my life-long career to fighting this growing health issue in Singapore. Renal medicine, with its complexity encompassing basic science, immunology, technology, and interventional procedures, presents a challenging specialty. I was, and remain, passionate about taking on these challenges to make a significant impact in the field of medicine.

Patients should consider consulting a renal physician when they have:

• Chronic kidney disease (CKD), particularly if it is progressing or is in the later stages (stages 3-5).
• Acute kidney injury (AKI), i.e. sudden loss of kidney function.
• Persistent abnormalities in urine tests, such as proteinuria (protein in urine) and/or haematuria (blood in urine).
• Diabetes complicated with kidney disease.
• Hypertension complicated with kidney disease.
• Family history of genetic kidney disease.
• Persistent or severe imbalances in electrolytes (such as sodium, potassium, calcium, or phosphate).
• Uncontrolled blood pressure despite on 3 to 4 blood pressure lowering pills.
• Unexplained swelling, especially in the legs, ankles, or around the eyes.
• Systemic diseases affecting kidneys such as lupus, vasculitis, or amyloidosis.

I dedicate time to reading journals and attending medical seminars, workshops, and conferences. Additionally, I am actively involved in teaching and research at the university as an adjunct assistant professor.

I believe each patient is unique, with distinct expectations and needs. Therefore, I personalise my care for each patient, considering both their medical requirements and emotional well-being to promote overall health. I actively involve patients in decision-making and encourage their empowerment in managing their health journey.

I have a significant number of patients at different stages of kidney disease who have been under my care for many years – some since I was a young registrar. I have witnessed their journeys, from graduating university, starting careers, getting married, and even becoming parents. Throughout our long-term patient-doctor relationship, they have shared their joys and sorrows, highs and lows of life with me. This bond inspires me to provide them with the best possible care throughout their entire lives.

Here are some common myths about kidney health that I have encountered:

• Myth: Drinking lots of water can cure kidney disease.

• Fact: While staying hydrated is important for kidney health, excessive water intake will not cure kidney disease. In fact, patients with advanced kidney disease may be advised to limit water intake to prevent fluid overload.

• Myth: Dialysis can reverse kidney disease.

• Fact: Dialysis is a treatment that helps manage kidney failure by performing some functions of the kidneys, but it does not reverse kidney disease.

• Myth: Kidney disease is always symptomatic.

• Fact: Early stages of kidney disease often present no symptoms, or symptoms may be subtle and overlooked. Regular screening through blood and urine tests is crucial for early detection.

• Myth: Herbal supplements are safe for kidney health.

• Fact: Many herbal supplements can harm kidney function, especially when taken in large doses or combined with prescription medications. Consultation with doctors before using any supplements is important.

• Myth: Kidney function worsens with kidney protective medications prescribed by doctors.

• Fact: Certain medications like ACE inhibitors, ARBs, and SGLT2 inhibitors may cause a mild increase in serum creatinine as they reduce kidney stress, which is an expected beneficial effect. Regular follow-up with doctors is important in managing chronic kidney disease.

I allocate sufficient time for discussing treatment options with patients, occasionally inviting their families to join our discussions. I utilise a variety of medical brochures and patient education materials, including links to informative internet materials and videos, to educate my patients. I encourage patients to reach out to me in writing or via contact methods if they have any concerns.

My clinic team members have been incredibly dedicated and supportive, relieving me of administrative responsibilities so I can focus on patient care. I also take occasional overseas vacations with my family to recharge and rejuvenate myself.

Some of the more exciting developments in the field of renal medicine include:

• Kidney xenotransplantation:
o Kidney transplantation is the preferred treatment for end-stage kidney failure but is limited by organ shortages. The first transplantation of a genetically modified pig kidney may offer insights into addressing this donor shortage.

• New medications such as SGLT2 Inhibitors, non-steroidal MRA, and GLP-1 Receptor Agonists:
o Recent large-scale research studies have shown that these medications protect the kidneys and slow down kidney failure. There are now more treatment options available for chronic kidney disease compared to the past.

• Newer dialysis technologies such as haemodiafiltration (HDF):
o HDF has demonstrated significant improvements in both the lifespan and quality of life of patients undergoing dialysis.

Here are seven tips for preventing kidney disease:

1. Regular Health Screening
• Early stages of chronic kidney disease often show no symptoms, making regular health screening crucial. Simple blood tests (such as serum creatinine and estimated glomerular filtration rate, eGFR) and urine tests (for proteinuria) can detect signs of kidney dysfunction early on.
• Screening helps in identifying CKD in its initial stages when interventions can effectively slow down its progression

2. Maintain A Healthy Diet
• A balanced and nutritious diet plays a significant role in kidney health. It should include moderate protein intake, low salt intake, adequate fruits and vegetable.
• Following a healthy diet helps maintain a healthy weight, manage blood sugar levels, and reduce the risk of conditions like diabetes and hypertension, which are major contributors to kidney disease.

3. Exercise Regularly
• Physical activity benefits kidney health by promoting cardiovascular health, maintaining a healthy weight, and reducing blood pressure. Aim for at least 150 minutes of moderate-intensity exercise per week, such as brisk walking, swimming, or cycling.

4. Avoid Smoking
• Smoking damages blood vessels and decreases blood flow to the kidneys, impairing their ability to function properly. It also increases the risk of kidney cancer.
• Quitting smoking reduces the risk of developing kidney disease

5. Avoid Overuse Of Pain Control Medication
• Certain pain medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), can harm kidneys if used excessively or over a long period. They can cause acute kidney injury and may worsen kidney function in those with pre-existing kidney disease.
• Use pain medications as directed by doctors and avoid prolonged or excessive use, especially if you have risk factors for kidney disease.

6. Avoid Diabetes or Control Diabetes Well
• Diabetes is a leading cause of kidney disease. Managing blood sugar levels through diet, exercise, and medication (if prescribed) is crucial in preventing kidney damage.
• Regular monitoring of blood sugar levels and adherence to treatment plans help reduce the risk of complications affecting the kidneys and other organs.

7. Avoid High Blood Pressure
• High blood pressure (hypertension) is a major risk factor for kidney disease. It can damage blood vessels in the kidneys, impairing their ability to filter waste products from the blood.
• Lifestyle modifications such as maintaining a healthy weight, reducing sodium intake, exercising regularly, limiting alcohol consumption, and taking medications as prescribed by doctors help manage blood pressure and protect kidney function.