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Kidney: Diseases, Screening & Treatment

Kidneys

The urinary tract consists of the kidneys, ureters , bladder, and urethra.

The kidneys are a pair of organs located in the back of the abdomen. Each kidney is about 7 or 8 inches long — about the size of a fist.
The kidneys’ function are to filter the blood. All the blood in our bodies passes through the kidneys several times a day. The kidneys remove wastes, control the body’s fluid balance, and regulate the balance of electrolytes. As the kidneys filter blood, they create urine, which collects in the kidneys’ pelvis — funnel-shaped structures that drain down tubes called ureters to the bladder. The bladder is a triangle-shaped chamber in the lower abdomen. Like a balloon, the bladder’s elastic walls stretch and expand to store urine.

Kidney Stone Disease

Kidney stones are one of the most painful disorders to afflict humans. Kidney stones are also one of the most common disorders of the urinary tract. It is estimated that 10 percent of all people in the United States will have a kidney stone at some point in time. Men tend to be affected more frequently than women.

Most kidney stones pass out of the body without any treatment by a doctor. Cases that cause lasting symptoms or other complications may be treated by various techniques, most of which do not involve major surgery. Research advances also have led to a better understanding of the many factors that cause stones to form, as well as modern ways to prevent them.

Kidney Stone Development

A kidney stone develops from crystals that separate from urine and build up on the inner surfaces of the kidney. Normally, urine contains chemicals that keep the crystals from forming. These chemicals do not work for everyone, however, and some people form stones. If the crystals remain tiny, they will travel through the urinary tract and pass out of the body in the urine without even being noticed.

Kidney stones may contain various combinations of chemicals. The most common type of stone contains calcium in combination with either oxalate or phosphate. These chemicals are part of a person’s normal diet and make up important parts of the body, such as bones and muscles.

A less common type of stone is caused by infection in the urinary tract. This type of uncommon stone is called a struvite, or infection stone. Much less common are uric acid stones and the rare cystine stone.

Doctors do not always know what causes a stone to form. While certain foods may promote stone formation in people who are more prone to them, scientists do not believe that eating any specific food causes stones to form in people who are not susceptible.

A person with a family history of kidney stones may be more likely to develop stones. Urinary tract infections, kidney disorders such as cystic kidney diseases, and metabolic disorders, such as hyperparathyroidism, also are linked to stone formation.

At-risk Groups

For some unknown reason, the number of people in the United States with kidney stones has been increasing over the past 20 years. Caucasians are more prone to kidney stones than are African Americans. Although stones occur more frequently in men, the number of women who get kidney stones has been increasing over the past 10 years, causing the ratio to change. Kidney stones strike most people between the ages of 20 and 40. Once a person gets more than one stone, he or she is more likely to develop others.

Symptoms of Kidney Stones

  • Pain is usually the first symptom of a kidney stone. The pain begins suddenly when a stone moves in the urinary tract, causing irritation or blockage. Typically, a person feels a sharp, cramping pain in the back and side in the area of the kidney, in the lower abdomen, or groin.
  • Nausea and vomiting
  • Blood in the urine
  • Frequent need to urinate
  • Burning during urination
  • If fever and chills accompany any of these symptoms, an infection may be present and your doctor should be contacted immediately.

Diagnosis of Kidney Stones

Kidney stones are found on an x-ray, CT scan, or sonogram taken on someone who complains of blood in the urine or sudden pain. These diagnostic images give the doctor valuable information about the stone’s size and location. Blood and urine tests help detect any abnormal substance that might make stones form.

The doctor may decide to scan the urinary system using a special x-ray test called an intravenous pyelogram, or IVP, or CT scan. Together, the results from these tests help determine the proper treatment.

Treatment of Kidney Stones

  • Most stones can pass through the urinary system with plenty of water – two to three quarts a day – to help move them along. In most cases, a person can stay home during this process and taking pain medicine as needed. The doctor usually asks the patient to save the passed stone or stones for testing.
  • Some type of surgery may be needed to remove a kidney stone if the stone does not pass after a reasonable period of time and causes constant pain, is too large to pass on its own, blocks the urine flow, or causes ongoing urinary tract infection.
    Extracorporeal shockwave lithotripsy (ESWL) is the most frequently used surgical procedure for the treatment of kidney stones. ESWL uses shock waves that are created outside of the body to travel through the skin and body tissues until the waves hit the dense stones. The stones become sand-like and are easily passed through the urinary tract in the urine.

    Percutaneous Nephrolithotomy is recommended to remove a very large stone. This treatment is often used when the stone is too large or in a location that does not allow effective use of EWSL. In this procedure, the surgeon makes a tiny incision, or opening, in the back and creates a tunnel directly into the kidney. Using an instrument called a nephroscope, the stone is located and removed. For large stones, some type of energy probe may be needed to break the stone into small pieces. Generally, patients stay in the hospital for several days and may have a small tube called a nephrostomy tube left in the kidney during the healing process.

Prevention of Kidney Stones

People who have had more than one kidney stone are likely to form another. Therefore, prevention is very important. To prevent stones from forming, their cause must be determined. The urologist will order laboratory tests, including urine and blood tests. A complete medical history will be taken, along with information about the patient’s work and eating habits. If a stone has been removed, or if the patient has passed a stone and saved it, the lab can analyze the stone to find out its chemical make-up.

  • The most important lifestyle change to prevent stones is to drink more liquids — water is best. Someone who has had stones before should try to drink enough liquids throughout the day to produce at least two quarts of urine in every 24-hour period.
  • Patients with too much calcium or oxalate in the urine may need to eat fewer foods containing calcium and oxalate. Not everyone will benefit from a low-calcium diet, however. Some patients who have high levels of oxalate in their urine may benefit from extra calcium in their diet. Patients may be told to avoid food with added vitamin D and certain types of antacids that have a calcium base.
  • Patients who have a very high level of uric acid in their urine may need to eat less meat, fish, and poultry. These foods increase the amount of uric acid in the urine.
  • The doctor may prescribe certain medications to prevent calcium and uric acid stones. These drugs control the amount of acid or alkali in the urine, key factors in crystal formation.

Kidney Cancer

Kidney, or renal cell, cancer (also called cancer of the kidney, renal adenocarcinoma, clear-cell cancer, or hypernephroma) is a disease in which cancer (malignant) cells are found in certain tissues of the kidney. There will be over 30,000 new cases of kidney cancer every year in the United States.

The kidneys are a “matched” pair of organs found on either side of your backbone. The kidneys of an adult are about 8 inches long and 4 inches wide, and are shaped like a kidney bean. Renal cell cancer is a cancer of the lining of the kidney’s tubules, tiny tubes that filter and clean the blood, remove waste products, and make urine.

Kidney cancer occurs more often in men than in women and accounts for only 3 percent of all adult cancers.

Symptoms of Kidney Cancer

  • Blood in your urine
  • A lump (mass) in your abdomen
  • A pain in your side that doesn’t go away
  • If you have cancer of the kidney, you may also feel very tired or have loss of appetite, weight loss without dieting, or anemia.

Diagnosis of Kidney Cancer

  • External Examination: If you have signs of cancer, the doctor will usually feel your abdomen for lumps.
  • Ultrasound / CT Scan: the doctor may also do an ultrasound, which uses sound waves to find tumors, or a special x-ray called a CT, or CAT-scan, to look for lumps in the kidney. CT-scans are also used to confirm the findings of the IVP and also to help determine the extent or spread of the cancer in and around the kidney. A special scan called magnetic resonance imaging (MRI), which uses magnetic waves to find tumors, may also be done.
  • Needle Biopsy: On rare occasions, a radiologist will do a needle biopsy, during which a very small amount of tissue is removed with a needle, to find out if the lump, mass, or cyst seen on the other tests is benign or malignant. Doctors perform very few needle biopsies of kidney tumors because of the danger of bleeding and other problems. The diagnosis can usually be made without them.

Once the diagnosis of kidney cancer is made, your prognosis, or chance of recovery, and treatment depend on your general state of health and whether the cancer is just in the kidney or has metastasized, or spread to other places in the body.

Treatment for Kidney Cancer

  • Surgery is the most common treatment for renal cell cancer. Your doctor may take out the cancer using one of the following procedures:
    Radical nephrectomy removes the kidney with the tissues around it. Some lymph nodes in the area may also be removed.
    Partial nephrectomy removes the cancer and part of the kidney around the cancer. This is usually done only in special cases, such as when the other kidney is damaged or has already been removed. In some very small cancers that are located at the very top or bottom of the kidney, we also can remove just the cancer, leaving the rest of the kidney intact.
  • Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body. Unfortunately, our success using chemotherapy for kidney cancer has been limited, but new drugs are being tested actively around the country.
  • Radiation Therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. External radiation therapy comes from a machine outside the body; internal radiation therapy is when a doctor puts materials that contain radiation through thin plastic tubes in the area where the cancer cells are found. Radiation can be used alone, or before or after surgery and/or chemotherapy.
    Radiation as primary treatment for kidney cancer has not met with great success. Radiation’s most common uses are to treat areas of cancer that have spread to bone or brain. On occasion, we will treat the kidney directly if the cancer cannot be removed and is causing symptoms, such as pain or bleeding.
  • Hormone Therapy uses hormones, taken by pill or injection, to stop cancer cells from growing. We are not sure why hormones work on some rare kidney cancers, but there does appear to be some limited action against the cancers in some patients.
  • Biological Therapy uses materials made by your own body or made in a laboratory to boost, direct, or restore your body’s natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy. The body’s immune system is used to fight the cancer like it would fight an infection.
  • Arterial Embolization also is used to treat renal cell cancer. A catheter, or narrow tube, is used to inject small pieces of a special gelatin sponge into the main blood vessel that flows into the kidney to block the blood cells that feed the tumor. This prevents the cancer cells from getting oxygen or other substances they need to grow.

Kidney cancer can often be cured if it is diagnosed and treated when still localized to the kidney. The disease is much more difficult to treat and cure when it has spread to other parts of the body.

If you are experiencing symptoms related to your kidneys call us to schedule an appointment for a complete evaluation to determine the best option for you.

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