How should I get screened for IgA nephropathy in Singapore?Kidneys
I'm a 24 year old male. My brother was recently admitted for IgA nephropathy and he has to start undergoing dialysis. I did some research and discovered that it could be due to genetics. I tried to consult private clinics to test for IgA nephropathy and was advised to go to polyclinic. However, the nurses at polyclinic were not able to give me a definitive answer if their screening would be able to detect it. I called CGH but was advised to head to a GP to get a referral to a kidney specialist. Can I get some advice?
I understand your worry given the unfortunate progression of your brother's disease. I hope he is coping well.
I agree with Dr Ethan's answer. A general practitioner can check your kidney function (creatinine and the glomerular filtration rate, i.e. your approximate percentage of kidney function) and check for blood and protein leakage in the urine.
I will add to check your blood pressure as well. High blood pressure is a common encounter and one crucial parameter that must be controlled to prevent added damage to the kidneys and prolong the functional life of the kidneys of patients who suffer this disease.
If the general practitioner finds anything abnormal in the screening assessment, hopefully not, he can refer you to a kidney specialist (nephrologist) in the public or private sectors. If everything is ok, hopefully, i would recommend you get those parameters checked yearly, lifelong, in order to detect it on time in case something comes up. At the same time, ensure you follow a healthy lifestyle and healthy weight lifelong to prevent further stress to your kidneys.
Alternatively, you can consult a private specialist of your choice directly, if you are too worried and would like to skip waiting times. He/she will advise you accordingly depending on the findings of your screen.
If many suspected cases, kidney biopsy is recommended for diagnosis confirmation and assess degree of the disease severity, especially if there is significant leakage of protein or the kidney function is subnormal. When the blood pressure is well controlled, the kidney function still normal, minimal leakage of protein and absence of markers of other causes of inflammation in the kidney (what we called a negative nephritic screen), the biopsy can be postponed until something changes; after discussing the pros and cons of watchful waiting (monitor your disease) vs doing the biopsy straight away.
I hope this information is useful. Wishing you the best possible health, Dr Francisco
Dr Francisco Salcido-Ochoa
MD, MRCP, PhD, MSc
MOUNT ELIZABETH NOVENA SPECIALIST CENTRE
#08 - 36/7/8/9 Singapore 329563
Screening and diagnostic tests have different meanings and purposes. A screening test is done to detect disease in people who do not have any symptoms of disease. You can read more about health screening tests in Singapore here.
A diagnostic test is performed to confirm the presence of disease.
In your case, IgA nephropathy can certainly be SCREENED for, at a GP clinic or at the polyclinic. Screening for IgA nephropathy is carried out by collecting a urine sample, and looking for blood or protein.
On the other hand, diagnosis for IgA nephropathy requires a kidney biopsy. This is an invasive procedure that is not done at the polyclinic. It involves taking a small piece of your kidney tissue for examination under a microscope.
Given your family history of IgA nephropathy, it sounds like the doctors who have seen you think it best for you to get a referral to see a kidney specialist (nephrologist).
They have given good advice to you, namely:
1. See a polyclinic GP, and explain your concern about IgA nephropathy in the context of your brother's diagnosis.
2. Your GP will write a referral letter to get you an appointment to see a kidney specialist at the hospital. The wait time for an appointment can be 2 - 4 weeks. The GP may also decide to perform certain basic screening tests at the same appointment as he sees fit, such as the urine dipstick test, and blood tests for your kidney markers. This is so that by the time your kidney specialist apppointment comes round, the results of the screening tests will be ready for the kidney specialist to analyse and interprete too.
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