In the early fifties, organ-centred specialties including Nephrology started to develop in Europe. It took more than a decade before such development came to this country. In 1962 a surgeon Mr. G.A. Sreenivasan returned from training overseas and became interested in developing Urology as a specialty. He was also interested in haemodialysis.

In 1964 Mr. Sreeni as he is popularly called persuaded the Ministry of Health to purchase a Kolff Dialysis machine which was placed in the General Hospital Kuala Lumpur. The machine was solely used for the treatment of acute renal failure and 85 haemodialysis were performed between 1964 to 1968. Peritoneal dialysis was introduced in the hospital by Dr. Sreeni in the last quarter of 1966 and again used solely in the treatment acute renal failure.

The Haemodialysis Unit was started temporarily in Ward 4 in 1969 before moving to its present building in 1970. The first patient to be accepted for long term haemodialysis was Mohamad Sabawi and he survived for more than three and a half years. Administratively, The Haemodialysis Uunit and the renal replacement therapy programme were under the Department of Urology. It was not until 1975 that a nephrologist Dr. Abu Bakar bin Dato' Suleiman (now Tan Sri Dato' Dr. Abu Bakar) took over the running of the dialysis unit and reorganised the treatment schedules and many other aspects of the haemodialysis programme.

In 1976, The Nephrology Unit was upgraded to a full department and this marked the beginning of a programmed and integrated development of renal replacement therapy in this country.

Haemodialysis - The Early Years

In 1969 chronic haemodialysis was started with a homemade tank system where the dialysate was prepared manually and channeled to the six dialysis machines which used the Kill dialysers. Vascular access was mainly through arteriovenous shunts, which often clotted. The Brescio-Cimino fistula for vascular access was only started in January 1977 by Dr. Proehoman, a consultant urologist.

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

A major milestone occurred in 1980 when a Reverse Osmosis water treatment system was installed. In 1977 and again in 1982 The Unit was expanded by the addition of ten beds.

Self-care through a Home Dialysis Programme was introduced in 1978 due to the increasing demand for haemodialysis. Patients were trained to do all aspects of the procedure including placing the fistula needles. With this programme patients who could afford dialysis machines from all over the country including Sabah and Sarawak were able to receive dialysis treatment. They had to undergo a three month training period at HKL in all aspects of haemodialysis.

Renal Transplantation

In 1975, Dr. Hussein Awang a consultant urologist performed the first renal transplantation (living related) in Malaysia. Since then nearly 829 transplants have been done and all but 108 were from living related donors. The first cadaver renal transplantation was performed in 1976. The cadaveric programme is gaining momentum after intensified campaigns targeted at doctors as well as the public, as our yearly cadaveric renal transplant has increase to approximately 20 per year since 2000.

Continuous Ambulatory Peritoneal Dialysis (CAPD)

This was introduced only in 1984 in this country. In the beginning only ten patients were selected and subsequently the number of patients have progressively increased over the years. At present there are 746 patients on this form of therapy. 

Neurology Client Meeting Day.
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CLINICAL SERVICES

The clinical services provided by the Department are comprehensive. These include in-patient acute dialysis, evaluation of patients with renal diseases, renal transplantation, management of patients with end-stage renal disease and outpatient clinics.

INPATIENT SERVICES

A wide variety of renal disorders are managed in the wards. These include patients with acute and chronic renal failure, glomerulonephritis, tubulointerstial diseases, urinary tract infection and obstructive uropathy and other related disorders. Various interventional procedures such as renal biopsies and central venous catheterization and various modalities of dialysis support are also provided. Patients upon discharge are subsequently followed up in the respective nephrology clinics. 

Recipes for Dialysis Patients.

CLINICAL SERVICES

The clinical services provided by the Department are comprehensive. These include in-patient acute dialysis, evaluation of patients with renal diseases, renal transplantation, management of patients with end-stage renal disease and outpatient clinics.

INPATIENT SERVICES

A wide variety of renal disorders are managed in the wards. These include patients with acute and chronic renal failure, glomerulonephritis, tubulointerstial diseases, urinary tract infection and obstructive uropathy and other related disorders. Various interventional procedures such as renal biopsies and central venous catheterization and various modalities of dialysis support are also provided. Patients upon discharge are subsequently followed up in the respective nephrology clinics.

OUTPATIENT SERVICES
The Department carries out the following outpatient activities:

CLINIC SCHEDULE

The Department also conducts clinics in the periphery (including Sabah and Sarawak) once every three months.

For more information, referral and appointments, please call 603-26155555-ext 6243

ACUTE DIALYSIS

Renal failure patients requiring dialysis either in the department or referred from other units are treated with either intermittent haemodialysis, peritoneal dialysis or continuous renal replacement therapy (CVVH,CVVHD)

END-STAGE RENAL FAILURE PROGRAMME

The Department provides hospital based haemodialysis as well as home peritoneal dialysis in the form of CAPD (Continuous Ambulatory Peritoneal Dialysis). Our haemodialysis center, comprising three units, has 36 stations and services over 164 patients. The continuous ambulatory peritoneal dialysis (CAPD) center is in between UN 2A & UN2B wards and services over 200 patients who dialyse at home. Patients are trained at the unit prior to starting therapy. These patients are seen regularly at three-month intervals at their respective clinics and acute problems are managed in the wards.

For more information , please contact 603-26156246 (Haemodialysis) Ext. 5909 (CAPD)

RENAL TRANSPLANTATION

Our renal transplant programme is primarily living related however the cadaveric programme is slowly gaining momentum. On average about 30-40 transplants are done each year. Of 138 new renal transplants in 2001, 30 were from living related donors, 38 from cadaveric donors done locally-the highest ever, 5 from commercial living non-related donors; and 63 from commercial cadaveric donors.

We evaluate potential donors and recipients before transplantation, manage them post-operatively and follow them up subsequently once discharged at the transplant clinics. Early and late complications post transplant are also managed by us.

For more information, please call 603-26155555 Ext 6715 (Transplant Clinic), Ext. 5385/6715 (Transplant Coordinator)

RENAL BIOPSY SERVICE

Elective biopsies are done on Tuesdays, Wednesdays and Thursdays while urgent biopsies are done on any weekday when necessary.

ANCILLARY SERVICES

This includes specialist dietitian, social worker and pharmacist.

The Department of Radiotherapy and Oncology provide training for therapeutic radiographers in collaboration with the Colleg of Radiotherapy and Radiography, Department of Public Health, Federal Territory. This training period is for 3 years and we have government sponsored candidates as well as those from local universities and private hospitals.

We provide post-graduate training for those who are interested in oncology as a career. Our centre is recognised by the Royal Colleges of England and Ireland for the part 1 of the Fellowship training.

The Department of Radiotherapy and Oncology is also the training center for practical training in post-basic oncology nursing run by the Training and Manpower Division of the Ministry of Health, whereby nurses following the post-basic course in oncology nursing are posted here for their practical attachment.

We have our own research unit called the Oncology Reseach Center (ORC).The ORC was set up in 2001 providing assistance and guidance to any staff of the department who are interested in doing any form of research projects related to radiotherapy and oncology.