Papers by Assoc . Prof . Dr Thin Han
Internal Medicine Journal
Translational Oncology
Highlights • The increased cancer incidence in patients with glomerular disease can be secondary ... more Highlights • The increased cancer incidence in patients with glomerular disease can be secondary to an intrinsic immune dysfunction associated with the disease or/and extrinsic factors, especially immunosuppressants.• Paraneoplastic glomerulopathy is sometimes misdiagnosed as primary glomerulopathy.• The treatment for paraneoplastic glomerulopathy is different from primary glomerular disease.• In membranous nephropathy, serum circulating autoantibodies against PLA2R and THSD7A, immunohistochemical tissue markers for glomerular PLA2R, THSD7A and specific types of immunoglobulin G (IgG) may be used for identifying underlying malignancies.• A scheme of screening of cancers frequently reported in the setting of glomerular disease is important.
Sun-protective strategies focusing on skin cancer awareness are needed in immunosuppressed patien... more Sun-protective strategies focusing on skin cancer awareness are needed in immunosuppressed patients at risk of skin cancers. The study aims to determine the effect of an integrated skin cancer education program on skin cancer awareness and sun-protective behaviours in renal transplant recipients (RTRs) and patients with glomerular disease (GD) treated with long-term immunosuppressants. A pilot prospective cohort study was undertaken in Central Queensland, Australia was undertaken among adult RTRs and patients with GD, who completed survey questionaries on skin cancer and sun-health knowledge (SCSK), sun-protection practices and skin examination pre- and post-education. Fifty patients (25 RTRs, 25 patients with GD) participated in the study. All of them completed questionnaires at pre-, 3-month post-education and 92%(n = 46) at 6-month post-education. There was a significant increase in SCSK scores from baseline at 3-months (p < 0.001) and 6-months post-intervention (p < 0.01)....
Open Journal of Nephrology, 2021
Aim: The objectives of this study are to determine the epidemiology of biopsy-proven glomerular d... more Aim: The objectives of this study are to determine the epidemiology of biopsy-proven glomerular disease (GD) in Central Queensland and the effect of a severe cyclone on its incidence and clinical phenotype. Background: Central Queensland (CQ) has a relatively high incidence of kidney disease. Since its biopsy service commenced in 2005, there have been no data on biopsy-proven GD. It has been suggested that GD incidence changes around times of natural disasters. In February 2015, the CQ region was affected by a category 5 Cyclone Marcia. This provides an opportunity to explore possible environmental triggers of GD. Methods: This was a single-centre retrospective observational study on biopsy-proven kidney disease in CQ. All kidney biopsies performed between January 2005 and December 2019 were included. Patients with biopsy-proven GD during 3 years before and after Cyclone Marcia (from 2012 to 2018) were analysed. Results: 170 native kidney biopsies occurred during the 15 years. The n...
Nephrology, 2021
With an increasing number of renal transplant recipients (RTRs) and improving patient survival, a... more With an increasing number of renal transplant recipients (RTRs) and improving patient survival, a higher incidence of non‐melanoma skin cancer (NMSC) has been observed. NMSC in RTRs are often more numerous and biologically more aggressive than the general population, thus contributing towards an increase in morbidity and to a lesser degree, mortality. The resultant cumulative health and financial burden is a recognized concern. Proposed strategies in mitigating risks of developing NMSC and early therapeutic options thereof include tailored modification of immunosuppressants in conjunction with sun protection in all transplant patients. This review highlights the clinical and financial burden of transplant‐associated skin cancers, carcinogenic mechanisms in association with immunosuppression, importance of skin cancer awareness campaign and integrated transplant skin clinic, and the potential role of chemoprotective agents. A scheme is proposed for primary and secondary prevention of NMSC based on the available evidence.
Nephrology, 2020
Background: There is no previous study that compare skin cancer awareness and photoprotective beh... more Background: There is no previous study that compare skin cancer awareness and photoprotective behaviours between renal transplant recipients (RTRs) and patients with glomerular disease (GD). Objectives/Methods: 61 RTRs and 51 patients with GD were given a self-reported questionnaire to evaluate skin cancer awareness and photoprotective behaviours in this crosssectional study. The former group received a formal education on skin cancer and the latter an informal session prior to immunosuppressant use. Results: 93% (n=57) of RTRs and 88% (n=45) of patients with GD responded to the survey. Majority of participants from both groups were aware that ultraviolet radiation could play a role in the occurrence of skin cancers and the awareness increased in participants with higher education (OR=1.50, 95% CI=1.15-1.95, p=0.003). 98% versus 71% were aware that immunosuppressants can increase the risk of developing cancer (p<0.001) and higher awareness was noted in younger participants (OR=0.92, 95% CI=0.87-0.97, p=0.003). Suboptimal photoprotective behaviours (sun avoidance, sunscreen usage, and sun-protective clothing) were noted in both cohorts and slightly lower sun protection rates were reported in RTRs when compared with patients having GD. The level of sun protective measures in RTRs based on high, moderate and minimal use of photoprotective measures were 21%, 46% and 33%, respectively. In terms of patients with GD, the latter practices were 13%, 50% and 37%, respectively (p=0.560). Higher educational status was significantly associated with better sunscreen usage in RTRs (p=0.017) whereas this finding was not observed in patients with GD. Conclusion: Patients with GD and RTRs should have formal education on the risks of skin cancers before starting immunosuppressants. Follow-up education and surveillance is required to improve skin protective practices in these patients .
Journal of Medical Cases, 2019
This is a case report of a patient who developed severe acute kidney disease with kidney biopsy s... more This is a case report of a patient who developed severe acute kidney disease with kidney biopsy showing interstitial nephritis, plasma cell infiltration and immunoglobulin G4 (IgG4) expression consistent with IgG4-related kidney disease. There were no other systemic features of IgG4-related disease. The patient was treated with corticosteroids and mycophenolate. This case highlights the need to consider IgG4-related kidney disease even in the absence of other systemic features. Isolated renal involvement is underrecognized and can lead to missed diagnosis. It also illustrates that mycophenolate can be used as a steroid sparing agent in this condition; an observation that adds to the limited literature in this field.
Journal of Medical Cases, 2019
Post-renal transplant diarrhea is a common clinical presentation. An extensive list of potential ... more Post-renal transplant diarrhea is a common clinical presentation. An extensive list of potential etiology adds to the diagnostic dilemma. In cases of prolonged or intractable diarrhea, invasive tests are often performed. Intestinal microsporidia can be diagnosed with simple non-invasive stool polymerase chain reaction (PCR). Based on this case, we propose an easy to follow flow chart and present a literature review on post-renal transplant diarrhea. Further multicenter validation testing is required for the proposed flow chart.
Kidney Medicine, 2019
on behalf of the CKD.QLD Collaborative Background: Acute kidney injury (AKI) contributes to and c... more on behalf of the CKD.QLD Collaborative Background: Acute kidney injury (AKI) contributes to and complicates chronic kidney disease (CKD). We describe AKI documented in hospital encounters in patients with CKD from the CKD Queensland registry.
Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, Jan 13, 2017
♦Background: The optimal time for the commencement of peritoneal dialysis (PD) after PD catheter ... more ♦Background: The optimal time for the commencement of peritoneal dialysis (PD) after PD catheter insertion is unclear. If dialysis is started too soon after insertion, dialysate leaks and infection could occur. However, by starting PD earlier, morbidity and costs can be reduced through lesser hemodialysis requirements. This is the first randomized controlled trial to determine the safest and shortest interval to commence PD after catheter insertion. ♦ Methods: All consecutive patients undergoing PD catheter insertion at the Royal Brisbane and Women's Hospital and Rockhampton Hospital from 1 March 2008 to 31 May 2013 who met the inclusion and exclusion criteria were invited to participate in the trial. Participants were randomized to 1 of 3 groups. Group 1 (G1) commenced PD at 1 week, group 2 (G2) at 2 weeks and group 3 (G3) at 4 weeks after PD catheter insertion. These groups were stratified by hospital and the presence of diabetes. Primary outcomes were the incidence of periton...
BMC Nephrology, 2010
Background: The most appropriate time to initiate dialysis after surgical insertion of Tenckhoff ... more Background: The most appropriate time to initiate dialysis after surgical insertion of Tenckhoff catheters is not clear in the literature. There is the possibility of peritoneal dialysis (PD) complications such as leakage and infection if dialysis is started too soon after insertion. However, much morbidity and expense could be saved by reducing dependency on haemodialysis (HD) by earlier initiation of PD post catheter insertion. Previous studies are observational and mostly compare immediate with delayed use. The primary objective is to determine the safest and shortest time interval between surgical placement of a Tenckhoff catheter and starting PD. Methods/Design: This is a randomised controlled trial of patients who will start PD after insertion of Tenckhoff catheter at Royal Brisbane and Women's Hospital (RBWH) or Rockhampton Base Hospital (RBH) who meet the inclusion criteria. Patients will be stratified by site and diabetic status. The patients will be randomised to one of three treatment groups. Group 1 will start PD one week after Tenckhoff catheter insertion, group 2 at two weeks and group 3 at four weeks. Nurses and physicians will be blinded to the randomised allocation. The primary end point is the complication rate (leaks and infection) after initiation of PD. Discussion: The study will determine the most appropriate time to initiate PD after placement of a Tenckhoff catheter.
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Papers by Assoc . Prof . Dr Thin Han