Dr. Amitabh Jha, Sr. Consultant & Head
Dr. Nabil Mohsin Al Lawati, Sr. Consultant
Dr. Issa Salim Al Salmi, Sr. Consultant
Dr. Sadiq Abdul Redha Abdul Baqi Al Lawati, Sr. Consultant
Dr. Ehab Mohammed Abdel Razek, Sr. Specialist
Dr. Pramod Kamble, Sr. Specialist
Dr. Abdelmassieh Metry, Specialist, Renal Transplant Coordinator
Dr. Abbas Pakkyara, Registrar Medical Officer
Dr. Muhammad Yasir Khalil, Registrar Medical Officer
Dr. Wasim Siddiqui, Registrar Medical Officer
Dr Shilpa Ramaih, Registrar Medical Officer
Dr Vinayak Jothi, Registrar Medical Officer
The Nephrology Unit endeavors to offer state of the art treatment in keeping with the highest international ethics and standards. It accords great importance to the cultural aspects, counseling and communication with patients.
The Royal Hospital is the major tertiary care hospital in Sultanate of Oman. While we offer the care for patients from the Muscat area, we also offer tertiary care consultations and treatment for the patients from all over the Sultanate of Oman. Clinical nephrology is very versatile and includes acute kidney injury, primary and secondary glomerular diseases, the latter due most following lupus and CKD (chronic kidney disease) essentially as a long term complication of diabetes and hypertension, to mention the major ones. We offer consultation for the inpatients of the different departments of the hospital. The department performs 70-80 kidney biopsies per year both from native as well as graft kidneys.
We offer dialysis in patients who develop acute kidney injury, slow continuous dialysis in patients in the intensive care unit with multi organ failure, initiate dialysis in patients going on for maintenance dialysis, in patients admitted for vascular access creation with the surgeons and in pateints on maintenance haemodialysis admitted for intercurrent events. The department performs the placement of temporary and semi-permanent tunneled catheters for dialysis. We would be having the largest number of Perm cath insertions by a single institution in the world. The number of dialysis conducted per annum has exceeded well above 4000 in the years 2009 and 2010. The modality of online haemodiafiltration is being introduced in the coming months, which will be a precious addition to the state of the art treatment.
This modality of renal replacement therapy was introduced in the mid 90s at the Royal Hospital, which also serves as an education and training centre for this technique for the whole country. Both CAPD (continuous ambulatory peritoneal dialysis) and APD (automated peritoneal dialysis) are available. The number of patients on peritoneal dialysis is on the steady rise.
Renal transplantation is the best option of renal replacement therapy. The Oman transplantation program was started in 1998 as a joint program between the Ministry of Health and the Sultan Qaboos University. The legislation in Oman is of the highest ethical and international standards. It permits transplantation from the living related donors. Relation is defined by blood and marriage. Brain death is considered a legal death and organ can be procured from a deceased donor for transplantation. Any commercialism by way of vending or buying an organ is prohibited and punishable.
The Nephrology Unit scrupulously follows the recommendations and directives of His Eminence the Mufti General of the Sultanate, the World Health Organization, the Transplantation Society and the Istanbul declaration on organ trafficking and transplant tourism. The team spends much time to explain to patients and relatives the ethical and legal transgressions of commercial transplantations as well as the bad outcome and complications. Unfortunately, still some patients opt for transplant tourism, though the number of such patients is decreasing. The reason behind this positive attitude is the excellent result of transplantations done in Oman and the increased awareness of the Omani population. Our objective is to reduce to zero transplant tourism.
A major boost for transplantation program took place in 2005 with the establishment of the transplant co-ordination unit and the kidney donor clinic. These two units were established with the cooperation of the Directorate General of Health Affairs. The positive results were immediate and, from a previous average of 6.5 transplantations per year, the number of transplantations increased to 12 in 2005, and 23 in 2009. At the moment we have more than 800 patients with functional renal transplant. We perform regular screening for a viral infection such as Cytomegalovirus, BK polyoma virus and Epstein-Barr virus.
Transplantations from deceased donors are almost nonexistent at the moment in our country. We hope that an organ procurement unit will be created soon at the major trauma and neurosurgery hospital not far away.
EDUCATION AND TRAINING
The Nephrology Unit is an affiliated department of the College of Medicine, Sultan Qaboos University. It offers clinical teaching for the 5th and 7th year medical students. The department offers formal teachings sessions for residents of the Oman Medical Specialty Board on major aspects of nephrology that the internal medicine residents should be familiar with.
CONTINUOUS MEDICAL EDUCATION
Realizing the importance of continuous medical and professional education, the department of nephrology has initiated several programs including:
- Sitting Grand Rounds on Saturdays and Tuesdays when the management of all the currently admitted patients is discussed.
- Journal Club on Tuesdays.
- Clinico-Pathological meeting on the 2nd Saturday of every month. This meeting was initiated in 2001 in collaboration with the Department of Histopathology of the Royal Hospital and Sultan Qaboos University Hospital.
- Nephrology Forum on the last Thursday of every month. This activity was started in 2011 where a case with a particular problem is presented and discussed while referring to journals, books and other resources like UPTODATE with an online Internet access till the establishment of the final diagnosis.
- Seminars in Nephrology and Transplantation held every 3 months. This meeting is held at the national level and was initiated by the department in 2001. The objective of these meetings is to establish guidelines and protocols in the management of various disease conditions.
The Unit has also organized in the past the following notable meets:
- Nephrology for Primary Care Physicians Symposium at National Institute of Health Sciences, Muscat during April 2008.
- European Donor Hospital Education Program (EDHEP) at Muscat in February 1997.
- Middle East Society of Organ Transplantation at Muscat in October 2002.
- Essentials in Organ Transplantation Symposium in collaboration with the Transplant Procurement Management (TPM), Les Heures, University of Barcelona at Khoula Hospital, Muscat in August 2008.
SCIENTIFIC AND CLINICAL INNOVATIONS
The Nephrology Unit at the Royal Hospital and the Department of Surgery at the Sultan Qaboos University and are the holders of the World Record for the youngest donor in Renal Transplantation. The donor was a premature neonate born after 35 weeks of gestation. The donation took place 10 days after birth, in 1994. The recipient is doing well 16 years later with the same kidney.
We were the third to report the regression of Sirolimus in Kaposi Sarcoma (KS) in general and the first to report the regression of visceral KS with Sirolimus (Exp Clin Transplant 2005). mTOR inhibitors are now the treatment of choice for KS in transplant patients.
The Declaration of Istanbul on Organ Trafficking and Transplant Tourism, April 30 to May 2, 2008 was a landmark in the history and ethics of transplantation. The department of nephrology at the Royal Hospital was a member of this forum which was jointly organized by the Transplantation Society, the International Society of Nephrology and the WHO.
The Unit believe that patients should receive standardized care all over the country. Accordingly, it has developed the following guidelines for the care of the renal patients treated in various regional referral hospitals in Oman:
- Guidelines for CMV prophylaxis and treatment in renal transplant patients.
- Guidelines for early detection, prevention and management of malignancy in renal transplant patients.
- Guidelines for management of FSGS.
- Guidelines for transplantation of Hepatitis C virus positive patients.
- Guidelines for renal transplantation in HBV positive situations.
- Guidelines for recognitions, prevention and treatment of Osteoporosis in post kidney transplant recipients.
- Guidelines for pregnancy in renal transplantation recipients.
- Guidelines for treatment of hyperlipidemia in renal transplant recipients.
- Guidelines on the use of erythropoietin in patients with chronic renal failure.
- Immunosuppression Guidelines in renal transplantation.
- Protocol for the follow up of patients with diabetic nephropathy.
As part of our role in the education of the patient, the family and the community we have developed the following educational printed materials:
- General advice for the transplant recipients
- Nutrition after renal transplantation
- Urine tract infections
- Taking a biopsy from the kidney.
As part of our endeavor to increase the community awareness in renal transplantation we organized in December 2009 the ‘Gift of Life’ meeting which gathered the donors and recipients of kidney transplants. That was the first occasion that our donors and recipients got together. The donors and recipients shared their wonderful experiences.
The 2nd ‘Gift of Life’ was organized in July 2011. The guest of honour was the Deputy Grand Mufti of the Sultanate of Oman who gave a valuable insight upon the social and religious aspects of organ donation..