#can nephrectomy cause renal failure

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Open Nephrectomy 2023

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Open Nephrectomy 2023

Like every organ, the kidneys are of great importance for human health. The kidney, which is located on both sides of the abdominal cavity and resembles a bean in shape, works like a filter in the human body and ensures that harmful and waste materials are removed from the body and the blood is cleaned. Thanks to this article, you can have information about the open nephrectomy operation used in the treatment of kidney diseases.

What is nephrectomy?

A healthy functioning of one of the kidneys in the human body is sufficient for the continuation of vital functions. However, in some cases, malfunctions in the kidney, which is so vital for human health, can cause an  increase  in urea and creatinine  in the body, resulting in kidney failure , damage to kidney tissue, and the formation of cancer in the kidney. In this case, it may be necessary to remove the sick kidney from the body by operation. The operation to remove the kidney from the body is called nephrectomy.

What is Open Nephrectomy?

Nephrectomy, which is the process of removing the kidney from the body, can be performed by open surgery or laparoscopic surgery. If the operation is performed with the open surgery method, this procedure is called open nephrectomy. In some cases, specialists may decide that it is not appropriate for the patient to remain under anesthesia for a long time. In this case, the laparoscopic (closed) nephrectomy method may be preferred as an alternative to the open nephrectomy method. Today, although the post-operative period is more comfortable, patients and specialists prefer the laparoscopic nephrectomy method, open nephrectomy is still one of the most effective methods used in the treatment of kidney diseases in cases where the laparoscopic nephrectomy method is not suitable.

In cases of polycystic kidney disease,

In the removal of tumor in kidney cancers  ,

In cases where the donor and the recipient must be together in the case of chronic kidney failure, which is seen as a result of long-term tissue damage in the kidney tissue,

In disorders of the pancreas.

There is the possibility of treatment with open nephrectomy method in many diseases from kidney cancer to kidney injuries, polycystic kidney diseases and pancreatic problems.

Nephrectomy can be grouped into two classes as partial nephrectomy and radical nephrectomy.

In some cases, removing the tumor tissue is sufficient to treat the disease. This procedure is known as partial nephrectomy. In some cases, since it is not possible to leave intact kidney tissue, the entire kidney must be removed during the operation. This procedure is called radical nephrectomy. If both kidneys are damaged, both kidneys may need to be removed from the body, but in this case, a kidney transplant is needed because it is not possible for the patient to live without their kidneys. Open nephrectomy operations are operations where the recipient and donor are together. Before this operation, some analyzes are performed on the receiver and the transmitter. If, as a result of these analyzes, the results of the recipient and the donor are compatible, the operation is started. The kidney from the donor is placed in the recipient. During this procedure, the healthy kidney is placed on the right or left side of the recipient. The process of taking a healthy kidney from the donor and attaching it to the recipient is known as donor nephrectomy.

In cases where kidney transplantation is required, the patient’s own kidney is not removed if the diseased kidney is not at risk of cancer or if there is no infection.

Open Partial Nephrectomy

In kidney cancer patients, nephrectomy operation, in which tumor tissue is removed and intact kidney tissue is left, is known as partial (partial) nephrectomy. During the partial nephrectomy procedure, the surgeon reaches the tumor through the opened incisions. For this reason, open nephrectomy method is preferred in partial nephrectomy operations. Open partial nephrectomy may be preferred in the following cases:

kidney cancers,

Infections in the kidney that cannot be treated with drug therapy,

Kidney failure,

The possibility of deterioration in the function of the other kidney,

Injuries to the kidney,

Conditions in which the blood supply of the kidney decreases as a result of occlusion in the vessels leading to the kidney,

Hypertension as a result of problems in the blood supply of the kidneys  ,

Congenital kidney anomalies.

During open partial nephrectomy, after an incision is made in the abdominal wall, the vessels leading to and exiting the kidney are clamped to prevent bleeding in the kidney. After the diseased tissue is removed, the clamp is removed and blood flow is restored to the kidney.

The duration of the open partial nephrectomy operation varies according to the size of the cancerous or impaired tissue. The procedure can be performed within 1-2 hours on average. However, as with any open surgery, there are some complications that may occur during open nephrectomy. Some of these complications are as follows:

During open partial nephrectomy, bleeding may occur that requires urgent blood supply.

The healing process can be long and accordingly  urinary incontinence  problems may occur.

Since the operation is performed in the form of open surgery, pain may be felt in the operation area for a few weeks after open partial nephrectomy.

Since open nephrectomy is performed under general anesthesia, allergic reactions to anesthesia may occur in some cases, but this is very rare because the necessary analyzes are performed by a specialist team before anesthesia.

After open partial nephrectomy surgery, patients are discharged within an average of 1 week. In the post-hospital period, patients are asked to pay attention to some points. In this process, the patient;

Should consume plenty of fluids,

Avoid doing heavy exercises until the surgical wounds are fully healed,

He should not neglect to go to his check-ups.

Open Radical Nephrectomy

Radical nephrectomy is a frequently used treatment method in kidney cancer treatments. In some cases, it is not possible to remove a part of the kidney, especially in the later stages of kidney cancer. In this case, the kidney and the fat tissue under the kidney must be completely removed. The process of removing the kidney completely is called radical nephrectomy. If the other kidney is healthy, one kidney will also perform the task of the kidney that was taken. However, in cases where there is a tumor in both kidneys and both kidneys need to be removed, kidney transplantation is necessary. In this case, open nephrectomy is performed with an operation where the donor and the recipient are together. If the kidney with tumor is not intervened, the tumor continues to grow and begins to damage other organs. This leads to many different health problems.

Radical nephrectomy can be performed as laparoscopic or open nephrectomy. In some cases, the operation is started with the closed surgery method and open nephrectomy can be started during the procedure.

General anesthesia is used during the open radical nephrectomy procedure. An incision is made under the ribs and the kidney is reached.

As with other surgeries, open radical nephrectomy has some risks. These risks can be listed as follows:

In patients who underwent radical nephrectomy with open surgery, pain after the operation is a common side effect.

In some cases, although rare, bleeding may occur during or after the operation.

Infection of the surgical wound is one of the rare side effects. In order to prevent this situation from happening, it is important to have dressing as the doctor says.

One of the rare conditions is intestinal obstruction.

After the partial nephrectomy procedure, as well as after the open radical nephrectomy, the patient will be sick for a while;

Should consume plenty of fluids,

Avoid lifting heavy loads

Intense exercises should be avoided.

Kidneys take on the task of filtering in the body and ensure that harmful substances and wastes are removed from the body. In case of any chronic or acute problem in the kidneys, harmful substances accumulate in the body and this adversely affects human health. Thanks to the developments in the medical world and the doctors who are experts in the field, it is possible to treat the diseases that occur in the kidneys. Do not forget to have the necessary controls for your health before it is too late.

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Renal Cyst Treatment Market: Size, Share, and Growth Forecast to 2032

Introduction

The renal cyst treatment market is projected to witness significant growth in the coming years, driven by the rising prevalence of kidney diseases, advancements in treatment methods, and increasing awareness about early diagnosis. Renal cysts are fluid-filled sacs that form in the kidneys and can lead to complications such as infections, high blood pressure, or kidney failure if left untreated. The global market for renal cyst treatment includes both medical interventions like drug therapies and surgical procedures aimed at treating or managing these cysts.

This article provides a comprehensive overview of the renal cyst treatment market, covering its size, share, emerging industry trends, and future forecast through 2032.

Market Size and Growth Dynamics

The renal cyst treatment market has shown a steady growth trajectory over the past decade. Renal Cyst Treatment Market Size was estimated at 2.77 (USD Billion) in 2023. The Renal Cyst Treatment Market Industry is expected to grow from 2.9(USD Billion) in 2024 to 4.2 (USD Billion) by 2032. The Renal Cyst Treatment Market CAGR (growth rate) is expected to be around 4.74% during the forecast period (2024 - 2032). Several factors contribute to the market's growth. The increasing incidence of polycystic kidney disease (PKD), a genetic disorder that causes numerous cysts to form in the kidneys, is a significant driver.

Moreover, the aging global population, a demographic more prone to kidney diseases, further fuels the demand for renal cyst treatments. Technological advancements in imaging techniques such as ultrasound and MRI have also enabled early detection and better management of renal cysts, contributing to the market's expansion.

Market Segmentation

The renal cyst treatment market can be segmented based on treatment type, end user, and geography.

By Treatment Type: The market includes pharmacological treatments such as analgesics and antihypertensive drugs, minimally invasive procedures such as cyst aspiration and sclerotherapy, and surgical methods like nephrectomy for severe cases.

By End User: The end users of renal cyst treatment include hospitals, specialty clinics, and ambulatory surgical centers. Hospitals dominate the market due to the availability of advanced equipment and specialized professionals. However, specialty clinics are expected to grow due to the increasing demand for outpatient procedures.

By Region: The renal cyst treatment market is regionally segmented into North America, Europe, Asia-Pacific, Latin America, and the Middle East & Africa. North America currently holds the largest share due to high healthcare expenditure, advanced medical infrastructure, and increased awareness about kidney disorders. The Asia-Pacific region is anticipated to witness the fastest growth due to the rising prevalence of renal diseases, growing healthcare infrastructure, and increasing medical tourism.

Key Market Trends

Technological Advancements: The development of minimally invasive treatment methods for renal cysts is a major trend shaping the market. Techniques such as laparoscopic cyst decortication and robot-assisted surgery offer patients less recovery time and fewer complications compared to traditional open surgery.

Pharmaceutical Innovations: Ongoing research into drug therapies for managing the symptoms of renal cysts, particularly in patients with polycystic kidney disease, is expected to propel the market. Advances in targeted therapies and biologics could revolutionize treatment approaches, reducing the need for invasive procedures.

Rise of Telemedicine: The global shift towards telemedicine is making it easier for patients to consult healthcare providers, leading to earlier diagnosis and treatment. Telehealth services, especially in rural or underserved regions, are increasing access to renal cyst management.

Increased Focus on Preventive Care: Preventive healthcare initiatives focused on reducing the risk factors associated with renal cysts, such as hypertension and diabetes, are becoming more prevalent. This is likely to boost the demand for early diagnostic tools and preventive treatments.

Challenges

Despite the market's growth, several challenges persist. High treatment costs, particularly for surgical interventions, remain a barrier in developing regions. Moreover, a lack of specialized healthcare professionals in some areas can limit access to advanced treatment options. Another challenge is the side effects associated with some pharmacological treatments, which may deter patients from adhering to long-term medication regimens.

Market Forecast (2024-2032)

The renal cyst treatment market is expected to experience significant growth over the forecast period. Increased investments in healthcare infrastructure, particularly in emerging markets, will drive demand. Moreover, the introduction of new, cost-effective treatments and ongoing research into genetic therapies for polycystic kidney disease may further stimulate market expansion.

North America is anticipated to maintain its dominant position, although the Asia-Pacific region is expected to close the gap as awareness and access to renal care improve. Meanwhile, Europe will see steady growth, driven by advancements in medical technologies and the increasing burden of chronic kidney diseases.

Conclusion

The renal cyst treatment market is poised for robust growth, fueled by the rising incidence of kidney-related disorders, innovations in treatment methods, and increased healthcare investments. By 2032, the market is expected to reach new heights as technological advancements and preventive care initiatives gain traction. The market's future holds significant opportunities for both established players and new entrants focused on providing innovative and cost-effective treatment solutions for renal cyst patients.

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Nephrectomy - Pyonephrosis surgery cost in Pune-meddco

To compare the price for Nephrectomy-pyonephrosis surgery in pune.

For this treatment this hospitals has affordable price and package for this treatment.this hospital may also provide you best doctor for this treatment.For more information please visit our website our

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Advances in Nephrectomy: A Comprehensive Overview of Pyonephrosis Surgery

Introduction:

Nephrectomy, the surgical removal of a kidney, is a procedure performed for various medical conditions affecting this vital organ. One such condition is pyonephrosis, a severe and potentially life-threatening infection of the kidneys characterized by the accumulation of pus. Pyonephrosis requires prompt intervention, often in the form of nephrectomy, to alleviate symptoms, prevent complications, and improve the patient's overall health. Understanding Pyonephrosis: Pyonephrosis arises when there is a blockage in the urinary tract, typically due to conditions such as kidney stones or tumors. This obstruction hinders the normal flow of urine, leading to the accumulation of infected fluid in the kidney. The infected fluid, comprising pus and debris, causes inflammation and damage to the renal tissue, resulting in a condition known as pyonephrosis. Indications for Nephrectomy in Pyonephrosis: Nephrectomy becomes a necessary intervention when pyonephrosis poses a significant threat to the patient's well-being. Common indications for nephrectomy in pyonephrosis include: Failure of Conservative Management: Initial attempts to manage pyonephrosis may involve antibiotics and other conservative measures. However, if the infection persists or worsens despite these efforts, surgical intervention becomes crucial. Presence of Abscesses: When the infection leads to the formation of abscesses within the kidney, surgical removal becomes imperative to prevent the spread of infection to adjacent tissues or bloodstream. Irreversible Kidney Damage: Prolonged pyonephrosis can cause irreversible damage to the kidney tissue, compromising its function. Nephrectomy is then considered to eliminate the source of infection and prevent further deterioration. Advancements in Nephrectomy Techniques: Recent years have witnessed significant advancements in surgical techniques, leading to improved outcomes and reduced morbidity in nephrectomy procedures, including those performed for pyonephrosis. Some notable advancements include: Minimally Invasive Approaches: Traditional open nephrectomies are being replaced by minimally invasive techniques such as laparoscopic and robotic-assisted procedures. These approaches offer smaller incisions, reduced blood loss, and faster recovery times for patients. Nephron-Sparing Techniques: In cases where partial kidney function can be preserved, nephron-sparing techniques are employed. This approach is particularly relevant in pyonephrosis cases where the infection is localized, allowing for removal of only the affected portion of the kidney. Enhanced Imaging Modalities: Advanced imaging technologies, including computed tomography (CT) and magnetic resonance imaging (MRI), aid surgeons in preoperative planning, allowing for precise identification of the extent of infection and optimal surgical strategies. Patient Management and Postoperative Care: Managing patients undergoing nephrectomy for pyonephrosis involves a multidisciplinary approach. Close collaboration between urologists, infectious disease specialists, and other healthcare professionals is crucial. Additionally, postoperative care is vital for ensuring a smooth recovery and preventing complications. Key aspects of patient management and postoperative care include: Antibiotic Therapy: Postoperatively, patients receive targeted antibiotic therapy to eliminate any residual infection and prevent the recurrence of pyonephrosis. Pain Management: Adequate pain control is essential for patient comfort and early mobilization. Minimally invasive techniques contribute to reduced postoperative pain, facilitating a quicker return to normal activities. Monitoring Renal Function: Regular monitoring of renal function is imperative to assess the remaining kidney's capacity to compensate for the loss of the removed organ. This involves periodic laboratory tests and imaging studies. Conclusion:

Nephrectomy for pyonephrosis represents a critical intervention in cases where conservative measures prove ineffective, and the infection poses a significant risk to the patient's health. With advancements in surgical techniques, imaging modalities, and perioperative care, the outcomes of nephrectomy procedures have improved, offering patients a better quality of life postoperatively. However, the decision to perform nephrectomy should be individualized, considering the patient's overall health, the extent of infection, and the potential for preserving renal function. As medical science continues to advance, the field of nephrectomy for pyonephrosis will likely see further refinements, enhancing the safety and efficacy of this surgical intervention.

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Open Nephrectomy

Kidneys, one of the most important organs of the body, undertake many tasks in maintaining general health. The main task of the kidneys is defined as filtering out some harmful and waste materials formed by the digestion of food taken orally through urine. However, the kidneys also maintain the balance of water and some minerals in the body, make vitamin D usable in the body, and secrete various hormones. For all these reasons, the deterioration of the working system of such an important organ is of vital importance for human health. A problem in this system can sometimes lead to kidney failure. In this case, the only solution for the person may be to remove the sick kidney from the body. Since there are two kidneys in the body, if there is a problem in one kidney, it is sufficient to remove the sick kidney from the body. If there is a problem in both kidneys, both kidneys are taken and the kidney taken from a cadaver or a volunteer living donor is transplanted to the patient. If the kidney or kidneys that are sick are to be removed from the body, this operation is called open nephrectomy if it is to be performed with the open surgery method.

What is open nephrectomy?

Open nephrectomy is a surgical procedure in which a surgeon removes one kidney from a patient's body through a large incision in the abdomen or flank. The procedure is performed under general anesthesia and may be used to treat kidney cancer, polycystic kidney disease, or other conditions that affect the kidney. During the surgery, the surgeon will disconnect the blood vessels and ureter that connect the kidney to the body and remove the organ. Open nephrectomy is a more invasive procedure than laparoscopic nephrectomy, which is a minimally invasive surgical technique that uses small incisions and specialized tools to remove the kidney. However, open nephrectomy may be necessary in certain cases, such as if the patient has a large tumor or if the surgeon needs to examine the kidney more closely during the procedure.

In which diseases is open nephrectomy used?

Open nephrectomy may be used to treat various diseases or conditions that affect the kidney, including: Kidney Cancer: Open nephrectomy is a common treatment option for renal cell carcinoma, the most common type of kidney cancer. Polycystic Kidney Disease: Open nephrectomy may be recommended for patients with polycystic kidney disease, a genetic disorder that causes the growth of multiple cysts in the kidneys. Kidney Trauma: Open nephrectomy may be necessary if a patient has severe kidney trauma, such as a ruptured kidney. Kidney Stones: In rare cases, open nephrectomy may be used to remove a large kidney stone that cannot be treated with other less invasive procedures. Hydronephrosis: Open nephrectomy may be used to treat hydronephrosis, a condition where the kidney becomes swollen due to the accumulation of urine. Pyelonephritis: Open nephrectomy may be used to treat severe or recurrent pyelonephritis, a bacterial infection of the kidney. The decision to perform an open nephrectomy will depend on the individual case and the patient's overall health. Other factors, such as the size and location of the tumor or the presence of other medical conditions, will also be considered.

How is an open nephrectomy done?

Open nephrectomy is a surgical procedure that typically takes 2-4 hours to perform and involves the following steps: Anesthesia: The patient is placed under general anesthesia to ensure they are unconscious and do not feel any pain during the procedure. Incision: The surgeon makes a large incision on the side of the patient's abdomen or flank, depending on the location of the kidney being removed. Disconnection of Blood Vessels: The surgeon carefully identifies and disconnects the blood vessels that supply the kidney, including the renal artery and vein. The ureter, which is the tube that connects the kidney to the bladder, is also detached from the kidney. Removal of the Kidney: Once the blood vessels and ureter have been disconnected, the surgeon removes the kidney from the body. Closure: The incision is closed with sutures or staples, and a sterile dressing is applied to the site. After the procedure, the patient is taken to a recovery room where they will be closely monitored for any complications. Most patients will need to stay in the hospital for several days to ensure they are healing properly and that there are no complications such as bleeding, infection, or blood clots. Pain medication and other supportive care will be provided to help manage any discomfort or side effects. In some cases, the patient may need to undergo additional treatments such as radiation or chemotherapy if the kidney cancer was not completely removed during the surgery.

Frequently Asked Questions

How is nephrectomy surgery done?

Nephrectomy surgery is a procedure in which one or both kidneys are removed from the body. There are several methods to perform a nephrectomy, including: Open Nephrectomy: An open nephrectomy involves making a large incision in the abdomen or flank to access and remove the kidney. This method is typically used when the kidney is too large, if there are many tumors, or if the tumor is located in a difficult-to-reach location. Laparoscopic Nephrectomy: A laparoscopic nephrectomy is a minimally invasive procedure that uses small incisions and specialized tools to remove the kidney. The surgeon uses a laparoscope, which is a thin tube with a camera attached to it, to guide the tools and remove the kidney. This method has a shorter recovery time and less pain than open nephrectomy. Robotic Nephrectomy: A robotic nephrectomy is similar to a laparoscopic nephrectomy, but the surgeon uses a robotic system to control the tools. This method provides greater precision and control for the surgeon. Partial Nephrectomy: A partial nephrectomy involves removing only a portion of the kidney, usually to treat small tumors. This method is typically used when preserving kidney function is important. Radical Nephrectomy: A radical nephrectomy involves removing the entire kidney, along with the adrenal gland, surrounding tissue, and nearby lymph nodes if necessary. This method is typically used to treat kidney cancer that has spread to other parts of the body. The choice of which method to use will depend on several factors, including the size and location of the tumor, the patient's overall health, and the surgeon's expertise. Each method has its own advantages and disadvantages, and the surgeon will determine which approach is best for the individual patient.

What does nephrectomy bilateral mean?

Nephrectomy bilateral refers to a surgical procedure in which both kidneys are removed from the body. This procedure is typically only performed when there is a serious medical condition affecting both kidneys, such as advanced kidney cancer, chronic kidney disease, or polycystic kidney disease. Bilateral nephrectomy is a major surgery that requires careful consideration and planning. If both kidneys are removed, the patient will require dialysis or a kidney transplant to maintain proper kidney function. Prior to the surgery, the patient will undergo a thorough medical evaluation to ensure they are healthy enough to undergo the procedure and have no underlying medical conditions that may complicate the surgery. After the surgery, the patient will require close monitoring and management of their kidney function. Dialysis or a kidney transplant will be necessary to replace the function of the removed kidneys. The patient may also require ongoing medical care to manage any complications or underlying medical conditions.

What is partial nephrectomy surgery?

Partial nephrectomy surgery, also known as kidney-sparing surgery, is a surgical procedure in which only the diseased or damaged portion of the kidney is removed, leaving the healthy portion intact. This type of surgery is typically performed to treat small or early-stage kidney tumors, as well as other conditions such as kidney cysts or benign tumors. During the surgery, the surgeon makes an incision in the patient's abdomen or side and carefully removes the affected portion of the kidney. The remaining healthy tissue is then stitched back together to maintain the structure and function of the kidney. Partial nephrectomy has several advantages over total nephrectomy, which involves removing the entire kidney. These include: Preservation of kidney function: Since only a portion of the kidney is removed, patients are more likely to retain their kidney function, which reduces the risk of developing chronic kidney disease or needing dialysis. Lower risk of complications: Partial nephrectomy is a less invasive procedure than total nephrectomy, which reduces the risk of complications such as bleeding, infection, or blood clots. Shorter recovery time: Patients who undergo partial nephrectomy typically have a shorter recovery time and experience less pain and discomfort than those who undergo total nephrectomy. Partial nephrectomy is a complex surgery that requires a skilled and experienced surgeon. The choice of whether to perform partial or total nephrectomy will depend on several factors, including the size and location of the tumor, the patient's overall health, and the surgeon's expertise.

How many hours does nephrectomy surgery take?

The duration of nephrectomy surgery depends on several factors, such as the type of nephrectomy being performed, the size and location of the kidney or tumor, and the patient's overall health. Open nephrectomy, which involves making a large incision in the abdomen or flank to access and remove the kidney, typically takes about 2 to 4 hours. Laparoscopic nephrectomy, which is a minimally invasive procedure that uses small incisions and specialized tools to remove the kidney, may take anywhere from 1.5 to 4 hours, depending on the complexity of the case. Robotic nephrectomy, which uses a robotic system to control the tools and provide greater precision and control for the surgeon, may also take between 1.5 to 4 hours, depending on the complexity of the case. Partial nephrectomy, which involves removing only a portion of the kidney, usually takes between 2 to 4 hours, depending on the size and location of the tumor and the patient's anatomy. It's important to note that the duration of the surgery is just one factor in the overall recovery process, and patients may require several days to weeks to recover fully, depending on their overall health and the type of surgery performed.

What is radical nephrectomy?

Radical nephrectomy is a surgical procedure in which the entire affected kidney, along with the surrounding tissue, lymph nodes, and sometimes the adrenal gland, is removed from the body. This type of surgery is typically performed to treat kidney cancer or other conditions that affect the entire kidney and surrounding tissues, such as a large kidney cyst or a benign tumor. During radical nephrectomy, the surgeon makes an incision in the patient's abdomen or side and carefully removes the entire kidney and surrounding tissues. The remaining healthy tissue is then stitched back together to maintain the structure and function of the urinary tract. Radical nephrectomy was once the standard treatment for most kidney cancers. However, with the development of partial nephrectomy and other minimally invasive procedures, radical nephrectomy is now typically reserved for cases where the cancer is large, aggressive, or has spread to other parts of the body. Radical nephrectomy is a major surgery that requires careful consideration and planning. Prior to the surgery, the patient will undergo a thorough medical evaluation to ensure they are healthy enough to undergo the procedure and have no underlying medical conditions that may complicate the surgery. After the surgery, the patient may require dialysis or other treatments to maintain proper kidney function. They will also require close monitoring and management of their overall health and any potential side effects or complications related to the surgery. Read the full article

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Urology Hospital in Vasna Ahmedabad, jivrajhealthcare.org

Urology Hospital in Vasna Ahmedabad

Our urinary system is the body’s toxic management plant. A slight dysfunction in it can uncomfort and pain. These problems may range from minor complaints to life-threatening complications.

The Urology department at Dr Jivraj Mehta Smarak Health Foundation (Dr Jivraj Mehta Hospital) is highly equipped to diagnose and treat all kinds of illness affecting the kidney, bladder, urethra, prostate and male genitalia in all age groups, independent of the origin or cause of the disorder.

Best Urology Hospital in Ahmedabad

Facilities

24 hours uro-care with daily morning and evening OPD

Minimal access urological emergencies

Urolithiasis management and prevention clinic

World class Dornier lithotripter with both sonographic and fluoroscopic localisation to treat all kinds of urinary stones at the most economical rates

World acclaimed Philips IITV with DSA facility

Urodynamic facility: state-of-the-art Urodynamics Laboratry to do investigative procedures

Urinary incontinence clinic

Specialised departments of Reconstructive Urology, Uro-Oncology and Paediatric Urology

Impotence and Andrology clinic: Facilities like Penile Doppler, Microscopic varicocelectomy, Vaso-epididymal anastomosis

Renal transplantation facilities: State of the art, well equipped operation theatre, team of skilled and experienced Urologists and Anaesthetists

Facilities for laparoscopic donor nephrectomy

Nephrology department to back up our transplant and renal failure patients

Post-operative ICU with trained nursing and Paramedical staff to take care of the patients

Management of urosurgical trauma patients

Post-operative care and close monitoring by surgeon and highly-trained staff.

Urology Hospital in Jivraj Park Ahmedabad

Services provided

Endoscopy surgeries for prostate (TURP), Bladder Tumor(TURBT), Urethra (OIU)

Endoscopic procedures like PCNL, Ureteroscopy and Cystolitholapaxy.

Hi-tech urological surgeries like Urocoil Placement, Endo-Balloon Dilation, Endo-Pyelotomy, Sting procedure.

Investigative procedures like Uroflometry, Cystometry, EMG, Pressure flow study and Video-Urodynamics.

Laparoscopic Urological Surgeries, Laparoscopic nephrectomy, Adrenalectomy, Lap. Pyseloplasty, Orchiopaxy, radial Prostatectomy, and VVF repair (vesico-vaginal fistula)

Management of Renal failure patients, A V Fistula, CAPD cannula insertion.

Surgery for stress urinary incontinence (TVI), artificial sphincter placement.

Contact us :-

For any information about our locations, doctors or services, please feel free to write or call us.

Hospital Address :-  Dr Jivraj Mehta Marg, Paldi, Ahmedabad, Gujarat 380007

Call us :-  079 2663 9839

Email us :-   info@jivrajhealthcare.org

Website us :-   http://www.jivrajhealthcare.org/

[cancertherapy]

Kidney (Renal Cell) Cancer - Symptoms, Risks and Types of Stages

Kidneys are two bean-shaped organs, each approx the size of an individual’s fist. They are located behind the intestines, with one kidney on both sides of the spine. Their main function is to clean the blood by removing waste products and making urine. The urine passes from each kidney by a long tube called a ureter into the bladder. The bladder stores the urine until it passes through the urethra and leaves the body.

Renal cell carcinoma (RCC) is also known as renal adenocarcinoma, hypernephroma, renal or kidney cancer. The rate of kidney cancer seems to be higher because imaging procedures such as computerized tomography (CT) scans are being used more often. These tests may develop the accidental discovery of more kidney cancers. At Cancer Therapy India, a multidisciplinary team of the best oncologist in Bangalore offers a variety of therapies to help keep an individual strong during and after treatment. 

Symptoms of Kidney Cancer

In the beginning, renal cell carcinoma does not usually cause any signs or symptoms. As the disease gets more severe, one might have some warning signs such as:

A lump on belly, side, or lower back

Blood in pee

Low back pain on both or one side

Losing weight for no clear reason

Not feeling hungry

Fever

Feeling tired and lazy

Not enough red blood cells (anemia)

Night sweats

High levels of calcium in the blood

High blood pressure

If you notice any of these symptoms then consult the visit to the best hospital in Bangalore for kidney cancer treatment.

Risk factors of Kidney Cancer

Factors that can higher the risk of kidney cancer include:

Older age

Smoking

Obesity

High blood pressure (Hypertension)

Treatment for kidney failure

Certain inherited syndromes

Family history of kidney cancer

Stages of Kidney Cancer

Kidney cancer is divided into 4 stages. They are:

Stage 1: In this stage, a tumor of about 7 cm or smaller appears in the kidney.

Stage 2: A tumor larger than 7 cm is in the kidney.

Stage 3: In this stage,

A tumor is in the kidney and has at least spread to one nearby lymph node.

A tumor is the kidney’s main blood vessel and may be in the close lymph node.

A tumor is in the fatty tissue around the kidney and may spread to the nearby lymph nodes.

A tumor grows into the veins or the perinephric tissues but not beyond the Gerota’s fascia or into the ipsilateral adrenal gland.

Stage 4: In kidney cancer stage 4,

Cancer has grown more and spread beyond the fat layer of tissue around the kidneys and may also be near the lymph nodes.

Cancer may have spread to other parts of the body such as the bowel, lungs, or pancreas.

Cancer has spread beyond Gerota’s fascia and spread into the ipsilateral adrenal gland.

Diagnosis of Kidney Cancer

If the surgeon suspects that an individual has kidney cancer, they’ll ask a few questions about personal and family medical history and then do a physical examination. Findings that can indicate kidney cancer include swelling or lumps in the abdomen, or, in men, enlarged veins in the scrotal sac (varicocele).

If kidney cancer is suspected, the surgeon will suggest several tests to get an accurate diagnosis. These may include:

Complete blood count

CT scan

Abdominal and kidney ultrasounds

Urine examination

Biopsy

Treatments for Kidney Cancer

The experts may recommend one or more kidney cancer treatment options depending on the stage.

Surgery

Surgery can involve different types of procedures. In a partial nephrectomy, part of the kidney is removed while in a nephrectomy, the complete kidney may be removed. Depending on how much cancer has spread, more extensive surgery may be required to remove surrounding tissue, lymph nodes, and adrenal gland. This is a radical nephrectomy. If both kidneys are removed, then dialysis or a transplant is compulsory.

Radiation therapy

Radiation therapy involves using high-energy or powerful X-rays to destroy cancer cells. Radiation therapy is sometimes Read More

[teachingrounds]

Autosomal Recessive Polycystic Kidney Disease

 A rare (1:25,000 live births) genetic defect due to PKDHD1 mutation on chromosome 6p that causes cystic dilation of the renal collecting ducts --> urinary concentrating defects --> polyuria, polydipsia + renal failure --> low sodium, high potassium, high phosphate, metabolic acidosis. There can also be hypertension +/- heart failure even with normal renal function. Poorly functioning kidneys do not produce vitamin D --> bone mineral disease. Large kidneys can also compromise the size and function of the stomach --> nephrectomy. N.B.--Worst-case scenario is Potter Syndrome: renal dysfunction --> oligohydramnios --> club foot + pulmonary hypoplasia = not compatible with life

[juniperpublisherscasestudies]

Juniper Publishers- Open Access Journal of Case Studies

Metachronous Pancreatic Metastases of a Bilateral Renal Cell Carcinoma : A Case Report

Authored by Soufiane Ennaciri

Abstract

We report the case of a 57-year-old patient who developed two pancreatic metastases eight years after surgical treatment of a bilateral renal cell carcinoma. A subtotal pancreatectomy with splenectomy was performed. Three years later, the patient is in good general condition and free from any tumor recurrence. Pancreatic metastases of kidney cancers are rare and onset usually late. They are most often fortuitous discovery during the surveillance of the neoplastic disease. The curative treatment is most often surgical.

Keywords: Pancreatic metastases; Bilateral renal cell carcinoma; Nephrectomy; Pancreatectomy

Introduction

Adult kidney cancer represents 3% of all cancers and the third urological neoplasm [1]. Metastases of renal cancers are usually located in the lung, liver or bones. Secondary pancreatic localization are unusual [2].

Case Report

A 57 years-old man, with a history of smoking, presented to the emergency room for a lower back pain and hematuria with blood clots.

The uroscan by computed tomography showed a bilateral kidney tumor. The left one was very large measuring 12x8x9cm taking up the lower two-thirds of the kidney. There was also a lymphadenopathy and no left renal vein thrombosis. The right kidney was occupied by an heterogenous polar superior tumor, measuring 4.3x5.1x5cm. Screening for metastasis was normal.

The patient under went at first a left radical nephrectomy. The anatomopathological study revealed a clear cell renal cell carcinoma : Fuhrman grade 3, stage pT2N0. Two weeks later, a right partial nephrectomy was performed and histological analysis found a clear cell renal cell carcinoma : Fuhrman grade 2, stage pT1N0 (Figure 1).

The survey was by CT without injection and MRI as the patient developed renal failure. Two years after nephrectomy, the imaging revealed two suspicious pancreatic nodules, on the body and the tail measuring 3 and 1cm respectively (Figure 2).

Endoscopic ultrasound with biopsy confirmed the metastatic nature of the pancreatic lesions. So the treatment was as à subtotal pancreatectomy with splenectomy. Besides the appearance of diabetes, there was no tumoral recurrence three years after the surgery.

Discussion

Clear cell renal cell carcinoma represents up to 90% of adult kidney cancers. Risk factors include mainly smoking and obesity [3]. The tumor is usually unilateral. In case of bilateral localization, a hereditary disease should be suspected and the surgical approach should be conservative [4] (Figure 3-5).

Pancreatic metastases of renal carcinoma are rare, representing 2 to 5% of pancreatic malignancies [5]. The average time between the nephrectomy and the metastasis diagnosis is 8 years [5] as it was the case for our patient.

Pancreatic metastasis are often asymptomatic. However, they can cause abdominal pain, jaundice, gastrointestinal bleeding, weight loss, exocrin or endocrin pancreatic insuffiency and even acute pancreatitis [5,6].

In most cases, there are discovered incidentally in imaging. Indded, doppler ultrasound and abdominal CT are firstline examination, they allow us to see the heterogenous and hypervascular character of the pancreatic lesion. RMI is of great help in case of renal failure. The result are similar to the CT scan but with better detection of the lesion before injection of contrast product wish is hypoitense on T1 and hyperintense on T2-weighted images [7].

The diagnosis can only be confirmed with the anatomopathological examination [8]. Which can be done after a guided CT, endoscopic ultrasound biopsy or after surgical excision [7].

Surgical excision is currently the best curative treatment. Depending on the lesions topography, a pancreaticoduodenectomy or a spleno-pancreatectomy can be performed [9,10].

Conclusion

Pancreatic metastases of clear cell renal cell carcinoma are rare and can occur many years after the nephrectomy, hence the interest of a careful surveillance. The accessebility of medical imaging leads to the early diagnosis at an asymptomatic stage, thus making them accessible for a surgical treatement, allowing a good survival rate in the long.

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For more articles in  Open Access Journal of Case Studies please click on: https://juniperpublishers.com/jojcs/index.php

[kidneyfoundationohio]

Educational Scholarship Recipients

The Educational Scholarship opportunity is designed to assist a kidney patient, or child of a patient, achieve their academic goals and complete a college or technical school education. Financial support is provided to students who have been diagnosed with kidney disease (or child of a kidney patient), demonstrate financial need and reside in the Foundation’s service area. The scholarship is renewable for a maximum of four years. A total of six students received assistance in 2020.

ANDREW BAIRD

At five years old, Andrew was diagnosed with Focal Segmental Glomerulosclerosis (FSGS), just three months after receiving a type 1 diabetes diagnosis. By the Spring of 2010, at eight years old, his illness had progressed to end-stage renal disease, leading to a double nephrectomy and fifteen months on dialysis.

Fortunately, in September of 2011, Andrew received a kidney transplant. Although he has continued to experience some difficulties, all major health struggles have subsided. Health is one of Andrew's top priorities, as he knows he will need another transplant one day. However, he states that "it can be an integral part of me without it defining me."

JAMI BELL

Due to a birth defect, Jami had one of her kidneys removed when she was only one and a half years old. Throughout childhood she struggled with frequent kidney infections that finally eased when Jami became an adult. In college, she was hospitalized with a life-threatening infection and kidney stones during her last semester at the University of Akron, which forced her to withdraw from school. Scarring from Jami’s health issues, as well as a few subsequent infections, caused her remaining kidney to eventually fail.

In 2015, Jami was diagnosed with End Stage Renal Disease (ESRD) and received a successful transplant at the end of 2019. Through social media, Jami has become heavily involved with educating people about ESRD while on her own quest to find a kidney donor, and created a Facebook support group for transplant recipients. Since her diagnosis, Jami has gone back to school at Cleveland State University where she plans to obtain her degree in Social Work.

ALEXANDRA BLANKFELD

Kidney failure is hereditary in Alexandra's family. Her father, Joel, was placed on dialysis in 2016. Prior to starting dialysis, he was a high-risk prostate cancer patient. 

Alexandra works part-time jobs to help support her family, and her own educational and financial goals. Although she has suffered from depression and anxiety due to the stresses of her father’s medical needs, Alexandra continues to persevere as she attends Cuyahoga Community College. She hopes to obtain a degree in Nursing, in hopes of becoming an ER nurse or working with dialysis patients.

MELINDA DJUKIC

Melinda’s mother has polycystic kidney disease (PKD), a genetic disorder, which resulted in her having both kidneys removed, being on dialysis for eight years, suffering from a stroke, and ultimately receiving a kidney transplant. Melinda spent a lot of time in the hospital, going to doctor’s appointments, and helping care for her mom as a young child.

Their family experienced financial issues after her mother received a transplant, so Melinda focused on working hard in school to get good grades so she could further her education through scholarships.

In addition to taking honors and AP courses, Melinda is passionate about creating art. She’s had illustrations appear in a few books and does commission work for family and friends.

Melinda, and her sister, were both recently diagnosed with PKD as well, but she is not letting that hold her back. She will attend the University of Cincinnati’s Design, Architecture, Art and Planning program in the fall. She hopes to pursue illustration or art therapy with a degree in Fine Arts.

NICOLE HARNISH

Nicole’s parents found out she had polycystic kidney disease when she was still in utero. At just three weeks old, she began dialysis. Fortunately, her mother was a match and donated her kidney to Nicole when she was one. Her first kidney lasted for 16 years, but she then had to go back on dialysis; 3 times a week for 4 hours each, for a year and half. In April of 2018, Nicole received her second kidney transplant. The biggest lesson Nicole has learned from her diagnosis is that you cannot be bound to what you can’t do; you have to learn to work with you can do! 

MACY KELLER

Macy was diagnosed with Focal Segmental Glomerulosclerosis (FSGS) and Nephrotic Syndrome in September of 2020. She has gone through various medicines and treatments since then to help her kidneys grow. However, it’s caused many changes in her body, left her in pain, and impacted her immune system a great deal. Macy will likely have to go on dialysis if the current courses of action don’t prove effective.

Before her diagnosis, Macy was hopeful to get a scholarship to play sports in college. Now that she is unable to do so, she wants to pick path where she can help people. She saw the nurses working first hand during her hospital visits, and fell in love with the career.

Macy will attend Malone University starting in the Fall of 2021 with the hopes of becoming a Registered Nurse.

LARRIA’N REDMOND

Larria’n has watched her mother struggle with End Stage Renal Disease (ESRD) her entire life and has spent hours with her during dialysis treatments. While her mother had received a kidney transplant, it only provided a short relief for the family, as the kidney has since failed. Larria’n’s mother has now been able to perform in-home dialysis treatments, which she does at least five days a week. After seeing the constant battle her mother faces from ESRD, Larria’n has been encouraged to work harder. She is a student at Notre Dame College studying Special Education. Throughout her academics, Larria’n is determined to provide her mother with the support she needs. 

COLLIN SCHUMM

Collin was diagnosed with post urethral valves while in utero that caused damage to his bladder and kidneys. He had several surgeries to help accommodate his conditions, but they could not reverse the damage that had already been done, or prevent more from happening.

His kidney function continued to decrease, and it became a challenge for him to play sports, something he loved. Fortunately, the summer before he started 7th grade, Collin received a kidney from his mom. After his transplant, he excelled as a varsity soccer player and took AP and advanced classes throughout high school. 

Collin firmly believes that his kidney issues have provided him with challenges that now guide his future.

ROMAN WENTZEL

Roman’s mother struggles with an autoimmune disorder that led to kidney failure. She received a transplant in June of 2020 at University Hospitals Transplant Institute. Roman learned a lot about the transplant process and organ donation during this time, and the importance of individuals helping one another.

He is involved with a variety of activities including swimming, choir, and band, and holds leadership positions in many of the clubs he’s in. During the time when his mother’s condition worsened, he worked hard to balance his commitments to his family, his activities, and his school work. Through it all, he maintained above a 4.0 GPA.

Roman says he wants “nothing more than to help change the world for the better, no matter how difficult the fight may be”. We wish him well in his endeavors this fall as he attends The Ohio State University to study Music Composition and Education, and Film Studies.

[uicscience]

Dr. Pier Giulianotti, chief of general, minimally invasive and robotic surgery at UI Health, with patient Christopher Adamsick, who on Sept. 24, 2020 was the first polycystic kidney disease patient to receive a robotic double nephrectomy and kidney transplant.

UI Health performs first-ever robotic kidney transplant for patient with polycystic kidney disease

Surgeons at UI Health — the University of Illinois Chicago’s clinical and academic health enterprise — have performed the world’s first robotic-assisted double-kidney removal followed immediately by a living-donor kidney transplant in a patient with severe polycystic kidney disease.

Christopher Adamsick, 50, of Yorkville, Illinois, underwent the procedure Sept. 24. Only a few days later, he reports being in high spirits and “very little pain.”

The procedure was led by Dr. Pier Giulianotti, chief of general, minimally invasive and robotic surgery at UI Health. 

“This is a first-of-its-kind procedure that normally requires open, invasive surgery and a very large incision. By doing the surgery robotically, the procedure is minimally invasive, the patient recovers faster, and we reduce the risk for surgical complications.”

Polycystic kidney disease is the fourth most common cause of renal failure in the United States, with approximately 150,000 Americans affected. It is an inherited disease in which clusters of fluid-filled cysts develop in the kidneys. These cysts can cause the kidneys to enlarge and lose proper function, leading to end-stage kidney disease.

A kidney transplant is the only cure for the disease.

Adamsick has had polycystic kidney disease for many years and was on dialysis for five weeks before a transplant became available at UI Health. He said he is happy to have such small surgical scars — just one 6-inch incision and five small incisions where the robot’s arms and instruments entered his body.  

“The disease can be very painful,” said Dr. Stephen Bartlett, a visiting clinical professor of surgery at UIC. “We always remove both kidneys when transplanting polycystic kidney patients. The cysts are not only painful, but they can rupture and cause internal bleeding and infection, and sometimes they get so big — up to the size of cantaloupes — that they squeeze the stomach and the person can’t get adequate nutrition and they lose weight.”

Bartlett pioneered the surgical removal of both kidneys — called a double nephrectomy — followed immediately by a kidney transplant to treat polycystic kidney disease years ago as chair of the department of surgery at the University of Maryland School of Medicine. The open surgical technique required an incision from the base of the sternum to the pubic bone. Some incisions can be up to 14 inches long.

“Traditionally, these patients had their kidneys removed first, went onto dialysis during recovery and were transplanted later in a second operation,” Bartlett said. “We combined the two procedures so that the person has one surgery instead of two and has a functional kidney when it’s all over to help them in the recovery.”

The next logical step, Bartlett said, was performing the combined surgery robotically to reduce the size of the incisions and improve recovery. When he was asked to join the UI Health transplant team, who have successfully demonstrated that robotic surgery can be used to improve recovery for numerous traditionally performed open surgeries, he jumped at the chance and came on board in February 2020.

Adamsick was an ideal patient for the robotic double nephrectomy and transplant, said Dr. Enrico Benedetti, the Warren H. Cole Chair of Surgery at UI Health, because of his weight.

“It’s harder for obese patients to be approved for transplant because there is a higher risk of complications,” Benedetti said, “but we have shown that robotic-assisted kidney transplant for obese patients is safe, and patients have fewer surgical complications because the incisions are smaller. So, when a kidney became available for him, we decided to do the double nephrectomy and transplant robotically during one procedure.”                

Giulianotti expects that Adamsick won’t be the only patient to undergo this unique surgical procedure for long.

“Polycystic kidney disease is very common, and the suffering associated with not only the disease but the traditional open surgery for transplantation and kidney removal is high,” Giulianotti said. “This first case should be very encouraging to patients with PKD who need transplants. The surgery is much less traumatic, and that our patient is doing well and reporting almost no pain only three days later is really promising.”

[atheevasanthosh]

KIDNEY DISEASE: SIGNS AND SYMPTOMS & TREATMENT

Why talk about kidney and its diseases? Is it really important to know more about it?

Of course! Discovering and learning more about your body is also a part of knowing you more. So love your body and yourself and let’s get introduced to some basic general knowledge about KIDNEY.

MEET THE PAIR OF BEAN-SHAPED ORGANS

Hello everyone! We are not boasting but believe us we really are a vital organ in your body. As you know, we are bean shaped twins about 4 or 5 inches which would match up to a large fist. Our main job is to clean your blood. We are the mighty filters that keep you healthy. We reside at the bottom of your rib cage, to each sides of your spine. We remove all the excess water, impurities, control your body fluids and keep the right levels of electrolytes. All the toxins and impurities are removed through urine. We also regulate pH, salt and potassium levels in your body. And they produce the hormones that regulate blood pressure and control the production of red blood cells. We also activate one form of vitamin D that helps your body absorb calcium.

DO YOU KNOW WHAT ALL PROBLEMS COULD A KIDNEY HAVE?

Kidneys are so hard working and never usually let you know their troubles unless it becomes really big and evident affecting your health. A million tiny filters called nephrons are there inside each of your kidney. So you would not be getting any prominent symptoms or problems even if 10% of your kidney is functioning.

Some of the major kidney diseases are:

Chronic kidney disease: This is the most common type. It is a long-term condition and doesn’t improve over time. They are mainly caused by high blood pressure and diabetes. In both the cases the blood vessels in kidney are affected, thus stopping kidneys functions to perform properly. This leads to kidney failure.

Kidney stones: This is also common. Kidney stones are formed when minerals and other substances in blood crystallize in the kidney forming masses (stones).

Glomerulonephritis: It is an inflammation of the glomeruli. Glomeruli are extremely small structures inside the kidneys that filter the blood.

Polycystic kidney disease:  It is a genetic disorder that causes numeric cysts (small sacs of fluid to grow in the kidneys). These can interfere kidney functions and cause kidney failure.

Urinary tract infections

Urinary tract infections (UTIs) are bacterial infections in any part of the urinary system.

HOW TO KNOW WHEN YOUR KIDNEYS ARE SICK

The following are the common signs and symptoms of kidney disease.

Fatigue: A severe decrease in kidney function can lead to accumulation of toxins and other impurities in blood causing tiredness and weakness. Also, as the kidney fails, they make less EPO (Eruthropoietin) hormones that tells body to make oxygen carrying red blood cells. With less oxygen supply you muscles and brain tire quickly.

Swollen feet/ hand or puffy face: As kidneys stop functioning and don’t remove extra fluids, it leads to sodium retention and causes swelling in feet or hands. Puffiness in the face, around your eyes is mainly due to the large amount of protein leak through urine.

Dry and Itchy skin: This is a sign of mineral and bone disease that accompanies advanced kidney disease when the kidneys fails to keep the right balance of minerals and nutrients in your blood.

Foamy and bubbly urine: This happens due to excess amount of protein in urine.

Muscle cramps: Muscle cramps occur when kidney doesn’t function properly in maintaining the level of electrolytes.

Trouble sleeping: As kidneys dysfunction, toxins stay in blood causing it difficult to sleep. Sleeping apnea (serious sleeping disorder in which breathing repeatedly stops and starts) is more common in chronic kidney disease.

Frequent urination: You might feel the need to urinate more especially at night as kidneys filters get damaged.

Food tastes like metal: A build-up of wastes in blood can make food taste different and cause bad breath. You may also have a poor appetite with symptoms like vomiting and upset stomach.

HOW CAN YOU TREAT YOUR KIDNEY BETTER?

Some of the treatments for kidney disease are:

Antibiotics: Kidney infections caused by bacteria are treated with antibiotics after studying the samples of blood and urine.

Nephrostomy: A tube (catheter) is placed through the skin into the kidney. This method is adopted to treat urine blockage.

Lithotripsy: Some kidney stones could be shattered into small pieces that can pass through urine. Often it is done by machines projecting ultrasound shock waves through the body.

Nephrectomy: Surgery to remove a kidney. Nephrectomy is performed for kidney cancer or severe kidney damage.

Dialysis: It is the artificial filtering of the blood to replace the work that damaged kidneys can't do. Hemodialysis is the most common method of dialysis. A person with complete kidney failure is connected to a dialysis machine, which filters the blood and returns it to the body. It is typically done 3 days per week in people with ESRD (End-stage renal disease) or kidney failure.

Peritoneal dialysis: A large amount of a special fluid is placed in the abdomen through a catheter which allows the body to filter the blood using the natural membrane lining the abdomen. After a while, the fluid with the waste is drained and discarded.

Kidney transplant: A kidney may be transplanted from a living donor, or from a recently deceased organ donor for restoring kidney functions.

Prevention is always better than cure. So to keep your kidney healthy, follow the basic measures like having a balanced diet, doing regular exercise and avoiding alcohol consumption and smoking. And if at all you are a kidney patient, take proper care of your health and be more cautious amid the covid-19 pandemic. You can always seek the help of one of the best online pharmacy- 3MEDS, in Delhi for fastest delivery of medicines and other health care products.

[siva3155]

300+ TOP UROLOGY Objective Questions and Answers

UROLOGY Multiple Choice Questions :-

1. The most ominous sign or symptom of urinary system disease is: A. Urinary frequency. B. Pyuria. C. Pneumaturia. D. Dysuria. E. Hematuria. Answer: E 2. A patient with acute urinary tract infection (UTI) usually presents with: A. Chills and fever. B. Flank pain. C. Nausea and vomiting. D. 5 to 10 white blood cells per high-power field (hpf) in the uncentrifuged urine specimen. E. Painful urination. Answer: E 3. Renal adenocarcinomas: A. Are of transitional cell origin. B. Usually are associated with anemia. C. Are difficult to diagnose. D. Are extremely radiosensitive. E. Frequently are signaled by gross hematuria. Answer: E 4. Ureteral obstruction: A. Is associated with hematuria. B. Is associated with deterioration of renal function and rising blood urea nitrogen (BUN) and creatinine values. C. Is commonly caused by a urinary tract calculus. D. Usually requires open surgical relief of the obstruction. E. Is usually associated with infection behind the obstruction. Answer: C 5. Stress urinary incontinence: A. Is principally a disease of young females. B. Occurs only in males. C. Is associated with urinary frequency and urgency. D. May be corrected by surgically increasing the volume of the bladder. E. Is a disease of aging produced by shortening of the urethra. Answer: E 6. Which of the following is/are true of blunt renal trauma? A. Blunt renal trauma and penetrating renal injuries are managed similarly. B. Blunt renal trauma with urinary extravasation always requires surgical exploration. C. Blunt renal trauma must be evaluated by contrast studies using either IVP or CT. D. Blunt renal trauma requires exploration only when the patient exhibits hemodynamic instability. E. Any kidney fractured by blunt renal trauma must be explored. Answer: D 7. Carcinoma of the bladder: A. Is primarily of squamous cell origin. B. Is preferentially treated by radiation. C. May be treated conservatively by use of intravesical agents even if it invades the bladder muscle. D. May mimic an acute UTI with irritability and hematuria. E. Is preferentially treated by partial cystectomy. Answer: D 8. The major blood supply to the testes comes through the: A. Hypogastric arteries. B. Pudendal arteries. C. External spermatic arteries. D. Internal spermatic arteries. Answer: D 9. Patients who have undergone operations for benign prostatic hypertrophy or hyperplasia: A. Require routine rectal examinations to detect the development of carcinoma of the prostate. B. Do not need routine prostate examinations. C. Have a lesser incidence of carcinoma of the prostate. D. Have a greater incidence of carcinoma of the prostate. Answer: A 10. The male contribution to a couple's infertility is approximately: A. 10%. B. 25%. C. 50%. D. 75%. Answer: C

UROLOGY MCQs 11. To maximize fertility potential, orchidopexy for cryptorchidism should be done before: A. Age 15 years. B. Age 12 years. C. Marriage. D. Age 2 years. Answer: D 12. Within the age group 10 to 35 years, the incidence of carcinoma of the testis in males with intra-abdominal testes is: A. Equal to that in the general population. B. Five times greater than that in the general population. C. Ten times greater than that in the general population. D. Twenty times greater than that in the general population. Answer: D 13. The appropriate surgical treatment for suspected carcinoma of the testis is: A. Transscrotal percutaneous biopsy. B. Transscrotal open biopsy. C. Repeated examinations. D. Inguinal exploration, control of the spermatic cord, biopsy, and radical orchectomy if tumor is confirmed. Answer: D 14. If torsion of the testicle is suspected, surgical exploration: A. Can be delayed 24 hours and limited to the affected side. B. Can be delayed but should include the asymptomatic side. C. Should be immediate and limited to the affected side. D. Should be immediate and include the asymptomatic side. Answer: D 15. Epididymitis, either unilateral or bilateral, in a prepubertal male: A. Is a frequent diagnosis. B. Can be dealt with on an outpatient basis. C. Is a major scrotal problem in this age group. D. Is a rare phenomenon. Answer: D UROLOGY Objective Questions with Answers 16. Patients with prostatitis, especially acute suppurative prostatitis: A. Should have residual urine measured by intermittent catheterization. B. Should have bladder decompression by urethral catheter. C. Should have repeated prostatic massage. D. Should have no transurethral instrumentation if possible. Answer: D 17. Benign prostatic hypertrophy with bladder neck obstruction: A. Is always accompanied by significant symptoms. B. Is best diagnosed by endoscopy and urodynamic studies. C. Is easily diagnosed by the symptoms of frequency, hesitancy, and nocturia. D. Is always accompanied by residual urine volume greater than 100 ml. Answer: B 18. Which of the following statements are true concerning male infertility? a. Although 15% of couples in the United States are affected by infertility, the male rarely contributes to the problem b. A varicocele can be associated with diminished sperm motility and abnormal sperm morphology c. Complete testicular failure will usually respond to systemic testosterone administration d. Anti-sperm antibodies are an important cause of infertility which may be treated successfully with corticosteroid administration Answer: b, d 19. A 65-year-old male is diagnosed as having prostatic cancer based on transrectal biopsy of a 1 cm palpable nodule. Which of the following statement(s) are true concerning his management? a. If the tumor is confined within the prostatic capsule (stage A or B), radical prostatectomy is an appropriate option b. If positive lymph nodes are detected on laparoscopic pelvic lymph node dissection (stage Dl), radical prostatectomy is indicated c. Radical prostatectomy is invariably associated with impotence d. External beam radiation is an appropriate treatment if the tumor is confined to the prostate e. There is currently no role for orchiectomy in the management of prostatic cancer Answer: a, d 20. Extracorporeal shock wave lithotripsy (ESWL) has had a dramatic effect on the management of urinary stones. Which of the following statement(s) are true concerning shock wave lithotripsy of urinary stones? a. The basic principle of lithotripsy involves the generation of shock waves which are focused fluoroscopically on the calculus and are delivered to the patient who is submersed in a water bath b. The most common complication after lithotripsy is ureteral obstruction secondary to stone fragments c. ESWL can be associated with stone-free rates ranging between 60%-95% at six months for renal and proximal ureteral stones d. The combination of ESWL with percutaneous nephrolithotripsy improves the results for stone clearance in patients with large or branched stones such as staghorn calculi Answer: a, b, c, d 21. Which of the following statement(s) are true concerning bladder carcinoma? a. Epidemiologic studies have implicated cigarette smoking as a risk factor b. If cystoscopy demonstrates a bladder carcinoma as the cause of painless hematuria, no further evaluation is necessary c. Multi-focal and recurrent bladder tumors are usually treated with transurethral resection and intravesical chemotherapy d. The results of treatment for locally advanced bladder tumors are similar with either radical cystectomy or radiation therapy Answer: a, c 22. The most common malignant neoplasm of the kidney is the hypernephroma or renal cell carcinoma. Which of the following statement(s) are true concerning renal neoplasms? a. Renal cell carcinomas can produce a variety of hormone or hormone-like substances b. Bilateral multifocal renal cell cancers can be associated with the multiple endocrine neoplasia syndrome c. A “tumor deformity” on IVP is diagnostic of a renal cell carcinoma d. Early control of the renal pedicle is an important aspect of surgical management of renal cell carcinoma e. Patients with renal cell carcinoma in a solitary kidney will inevitably require total nephrectomy and long-term dialysis for the resultant renal failure Answer: a, d 23. A 28-year-old white male presents with asymptomatic testicular enlargement. Which of the following statement(s) is/are true concerning his diagnosis and management? a. Tumor markers, b-fetoprotein (AFP) and ?-human chorionic gonadotropin (HCG) will both be of value in the patient regardless of his ultimate tissue type b. Orchiectomy should be performed via scrotal approach c. The diagnosis of seminoma should be followed by postoperative radiation therapy d. With current adjuvant chemotherapy regimens, retroperitoneal lymphadenectomy is no longer indicated for non-seminomatous testicular tumors Answer: c 24. Which of the following statement(s) is/are true concerning benign prostatic hypertrophy (BPH)? a. Prostatic size has no consistent relationship to urethral obstruction b. Renal failure secondary to obstructive uropathy occurs as bladder pressure rises and is eventually transmitted proximally to the renal pelvis c. Hormonal treatment for BPH involves treatment with a 5 a-reductase inhibitor which blocks the conversion of testosterone to the dihydrotestosterone d. Intermittent catheterization, although a temporizing measure, is not an effective treatment for relief of symptoms of BPH Answer: a, b, c 25. A 55-year-old male presents with severe flank pain radiating to the groin associated with nausea and vomiting. Urinalysis reveals hematuria. A plain abdominal film reveals a radiopaque 5 mm stone in the area of the ureterovesical junction. Which of the following statement(s) is/are true concerning this patient’s diagnosis and management? a. A likely stone composition for this patient would be uric acid b. The stone will likely pass spontaneously with the aid of increased hydration c. Stone analysis is of relatively little importance d. Patients with a calcium oxalate stone and a normal serum calcium level should undergo further extensive metabolic evaluation Answer: b 26. Which of the following statements are true concerning male impotence? a. Psychologic factors account for less than half the cases of male impotence b. Vascular testing for vasculogenic impotence may include Doppler determination of penile systolic blood pressure and super selective pelvic arteriography c. Penile implants are the first line treatment for patients with impotence due to diabetes or vascular dysfunction d. Impotence associated with abdominal perineal resection is due to direct trauma to pelvic nerves and may be improved with papaverine injection Answer: a, b, d 27. Which of the following statement(s) are true concerning the detection and diagnosis of prostatic cancer? a. An elevation of prostate specific antigen (PSA) is highly sensitive and specific for prostatic carcinoma b. American blacks have an increased risk of prostatic carcinoma c. Autopsy series would suggest that 10% of men in their 50’s will have small latent prostatic cancers d. Transrectal prostatic biopsy is indicated for a palpable 1 cm prostate nodule e. Serum prostatic acid phosphatase remains the most useful tumor marker for prostatic carcinoma Answer: b, c, d UROLOGY Questions and Answers pdf Download Read the full article

[garden-of-everything]

ABIM: Oncology

ABIM syllabus can be found here Let me know if you find any errors Sources: UWorld, MKSAP 16/17, Rizk Review Course, Louisville Lectures, Knowmedge (free version)

Lung cancer (clinical presentation and diagnosis)

Small cell:  associated with hyponatremia/SIADH, Lambert Eaton (like MG but fatiguable); Tx: chemotherapy + whole brain radiation if good response to chemo Non-small cell:  CT/PET, MRI brain –> Tx: stage I - surgical, stage II - surgery + chemo, stage III - chemo + XRT +/- surgery, stage IV - chemotherapy alone (1)  Squamous cell carcinoma:  associated with smoking, hypercalcemia, Pancoast tumors (cause Horner’s: ptosis, miosis, anhydrosis) (2)  Adenocarcinoma:  not associated with smoking (3)  Large cell carcinoma:  associated with SVC syndrome (4)  Bronchogenic carcinoma:  associated with cluster of painless, firm/hard cutaneous metastases *AE of chest XRT is CAD

Breast Cancer

- Screening:  mammogram >50yo or >35 with high risk * if palpable mass:  ALWAYS BIOPSY (even if not seen by mammo) * if in situ –> no need for LN biopsy * if positive LN –> axillary LN dissection (AE: UE lymphedema) *if >1cm or LN+: give adjuvant chemo * do NOT perform mastectomy if metastized * if mastectomy, add XRT if: (1) dermal invasion, (2) close margins, (3) 4+ LNs - Dx:  mammogram/US –> Bx –> ER/PR/Her2neu status - DCIS Tx: lumpectomy + local rads = simple mastectomy (for tumor >5cm) +/- if ER/PR+ –> 5 years of hormonal therapy (1) premenopausal: Tamoxifen (SERM; AE: clots, endometrial cancer), (2) postmenopausal: Anastrazole/Letrozole (AI) +/- if Her2neu+ –> get an ECHO to ensure good heart function, give Trastuzumab (- LCIS Tx: observe or b/l mastectomy (won’t be tested because controversial)

Neoplasm of the head and neck

Thyroid nodules and thyroid cancer: (1) Medullary thyroid cancer: associated with both MEN II syndromes, RET gene; elevated calcitonin –> hypercalcemia; Tx: surgical neck dissection (2) Papillary thyroid cancer:  aggressive, associated with BRAF (like melanoma); Tx: surgery + radioiodine (3) Follicular:  Tx: surgery + radioiodine (4) Anaplastic:  very poor prognosis

Gastrointestinal or hepatic cancer

Stomach cancer:   - Dx: upper endoscopy with ultrasound > CT scan - Tx: surgery, chemo, XRT - MALT lymphoma:  Tx: PPI and H.pylori Abx Colorectal cancer: - Tx: stage 1-2: resect, III: resect + chemo, IV: FOLFOX chemo +/- resect + Bevacizumab - f/u with CEA Q3-6mo for 2 years, then Q6months for 3 years - f/u with CT chest/ab/pelvis every year for 3 years - f/u with colonoscopy 1, 3, and 5 years post-treatment - Rectal cancer: Tx stage II-III: (1) chemo/XRT –> surgery or (2) surgery –> chemo Pancreatic carcinoma other than pancreatic endocrine tumors: - Trousseau venous thrombophlebitis (migratory VTEs), jaundice, palpable GB - stage I (pancreas) Tx: resection - stage II (duodenum) - stage III (LN) - stage IV (other mets) Tx: Gemcitabine *confused for autoimmune pancreatitis (because of mass); differentiate with biopsy; AIP has elevated IgG Hepatocellular carcinoma: - associated with Hep C > chronic Hep B - if nodule <1cm needs screening abdominal US Q6mo –> if >1cm: contrast CT/MRI liver (arterial phase enhancement) - if AFP>100, don’t have to biopsy –> Tx: resection / liver transplant > EtOH/radioablation > chemotherapy/Sorafenib Other CT abdomen findings: (1) Cavernous hemangioma: early peripheral nodular enhancement with delay in filling from periphery to center; don’t have to treat (2) Hepatic adenoma: associated with OCPs; early rapid loss of enhancement –> resect (3)  Focal nodular hyperplasia:  central stellate scar –> don’t have to treat

Urologic cancer

Renal clear cell carcinoma:   - presents as upper abdominal mass with hematuria; erythrocytosis (elevated Hb), hypercalcemia, and acute varicocele - associated with von-Hippel Lindau (retinal and cerebellar hemangioblastomas and RCC) - Dx: CT ab, pulmonary “cannonball” nodules/mets on CXR, if bone pain: elevated ALP - Tx: nephrectomy Transitional cell carcinoma: - painless hematuria - Dx: cystoscopy - Tx: TURBT –> intravesicular BCG; if muscle invasion: radical cystectomy Prostate cancer: - Dx: exam with elevated PSA –> transrectal US-guided prostate Bx - Gleason >7, PSA >15, large tumor or bone pain –> bone scan and CT ab/pelvis - penetrates prostate capsule Tx: XRT –> f/u PSA and rectal exam Q6-12mo - LN involvement/mets/elevated serum acid phosphatase Tx:  total hormonal ablation with 4-6mo Leuprolide (LHRH agonist to be given with antiandrogen Flutamide to prevent tumor flare)/Goserelin –> refractory: Docetaxel Testicular cancer: (1) Non-seminoma (embryonal, teratoma, choriocarcinoma): elevated AFP, hCG; Dx/Tx: inguinal orchiectomy (DO NOT BIOPSY) +/- chemo if spread (2) Seminoma: elevated hCG; Tx: radiation; if disseminated: platinum-chemo

Gynecologic cancer

Ovarian cancer: - may present with bleeding, dyspareunia, ascites (SAAG <1.1, ascites protein >2.5), peritoneal carcinomatosis - associated with HNPCC, infertility, early menarche, late menopause - Dx: pelvic U/S –> stage with ex-lap - Tx: stage I = surgery; stage II-IV: platinum-based chemo –> follow with pelvic exa, and CA-125 Q2-4mo for 2 years (do NOT need routine US) * if BRCA1 or 2+ –> offer oophorectomy at 35yo or after child-bearing * Dermatomyositis (anti-Jo1) is associated with ovarian cancer –> TVUS Endometrial cancer: - Dx: with biopsy - Tx: surgical resection of cervix/uterus/adnexa + XRT +/- chemotherapy; if high risk surgical patient, XRT only Cervical cancer: - Dx: punch bx or colposcopy bx - stage I Tx: LOOP/conization or if finished babies, hysterectomy WITHOUT dissection - stage II-IV Tx: XRT + cisplatin

CNS tumors

GBM: most common and aggressive adult intraparenchymal tumor - ring-enhancing with central necrosis and hemorrhage Meningioma: most common primary brain tumor (extraparenchymal, extradural) - insidious diffusely enhancing, partially calcified +/- dural tail; Tx: observe or surgery if symptomatic Oligodendroglioma:  rare, MRI = non-enhancing homogeneous intraparenchymal lesion Schwannoma: benign nerve sheath tumor ~CNVIII (hearing loss/tinnitus) - MRI shows enhancing lesion at cerebellopontine angle vs. Pseudotumor cerebri:  headaches worse in the morning + papilledema and visual changes in an obese person on Accutane - Dx: CT/MRI to r/o tumor and dural venous sinus, LP shows elevated ICP - Tx: Acetazolamide, repeat lumbar puncture –> if progressive visual loss: neurosurgery

Skin cancer

Squamous cell carcinoma:  preceded by actinic keratosis Basal cell carcinoma: raised pearlescent with telangiectasia Melanoma: Dx: wide excision + if >1mm deep, sentinel LN biopsy; additionally treat with IFN if >4mm or +LN

Hematologic malignancies (see ABIM: Hematology)

Assorted endocrine tumors and endocrine manifestations of tumors (see ABIM: Endocrine)

Malignancy associated hypercalcemia: (1) squamous cell (2) RCC (3) medullary thyroid cancer (elevated calcitonin)

Oncologic emergencies

SVC Syndrome :  associated with large cell NSCLC - Dx: biopsy tissue > mediastinoscopy/thoracotomy - if previously untreated: give chemo - if previously treated: XRT +/- chemo Fever and neutropenia: - Tx: with broad spec Pseudomonal abx (Cefepime) until PMN>500 - if no improvement in 2 days, add Vanc - if no improvement in 5 days, add Itraconazole Spinal cord tumors and compression: - Dx: Gad-enhanced MRI - Tx: steroids, surgery, XRT Cardiac tamponade from neoplastic pericarditis: - JVD, tachycardia, pulsus paradoxus - Tx: pericardiocentesis Tumor lysis syndrome: - elevated uric acid, potassium, phosphate - N/V/D, heart failure, seizures, syncope, death - PPx: Allopurinol, Rasburicase Hypercalcemia  - elevated Ca, decreased PTH, normal/decreased Vit D3 and Phos - Tx: NS Hyponatremia (SIADH): - associated with small cell - Tx: fluid restrict or if symptomatic, Na<120: 3% Saline + Lasix

Complications of cancer and its treatment

- give Morphine –> translate it to long-acting forms - Palliative O2 not helpful in absence of hypoxemia - Radiation toxicity: CAD, hypothyroidism, lung disease; breast, lung, esophageal cancer - Toxicity bear (borrowed from my Step 1 notes - Second Aid): –> Asparagine: neurotoxicityCisplatin:  ototoxic/nephrotoxic; Tx: Amifostine –> Vincristine/Vinblastine:  "Christ my nerves, Blast my bones" - Vincristine = peripheral neuropathy - Vinblastine = myelosuppression –> Bleomycin: pulmonary fibrosis –> Doxorubicin: cardiotoxic; Tx; Dexrozoxane (for cardiotoxicity), Dimethyl-sulphoxide (for ROS ulcers) –> Cyclophosphamide:  Acrolein = nephro/bladder toxic (Tx: Mesna); also SIADH effects (Tx: Demeclocycline) –> Methotrexate: nephrotoxic (Tx: Leucovorin), myelosuppression (Tx; Filgrastim)

Cancer of unknown primary

- axillary LN? –> biopsy comes back adenocarcinoma –> mammogram –>if neg: MRI breast - high cervical LN? –> PET/CT scan of head and neck - osteoblastic mets? –> PSA test for prostate adenocarcinoma - ascites, peritoneal carcinomatosis? –> ovarian cancer, Dx: ex-lap - young woman with retroperitoneal poorly differentiated mass? –> germ cell cancer; Tx: platinum chemo

Cancer screening (see ABIM: Screening)

[juniperpublishersanesthesia]

Hyperkalemia Management in the Oncology Patient: A Case of Sodium Polystyrene Sulfate Induced Bowel Perforation-Juniper Publishers

Abstract

Kayexalate (sodium or calcium polystyrene sulfate) is a cation-exchange resin commonly used to treat hyperkalemia in patients with renal dysfunction. It works by exchanging its bound sodium with potassium in the colon to promote potassium excretion in the stool. This occurs over hours to days, and is known to cause adverse digestive effects including anorexia, nausea, vomiting, and constipation. Bowel necrosis and perforation is an uncommonly recognized, though devastating complication of kayexalate administration. We present a case of a postoperative surgical oncology patient who developed a bowel perforation associated with oral kayexalate administration. We also review the literature to further delineate the relationship between the use of kayexalate and bowel perforation and necrosis, particularly in a surgical oncology patient where this complication has been less frequently documented.

Keywords: Kayexalate; Hyperkalemia; Bowel perforation; Bowel necrosis; Sodium polystyrene sulfate; Calcium polystyrene sulfate

Introduction

Hyperkalemia is a condition commonly encountered in medical and surgical patients and can induce life-threatening cardiac arrhythmias if left untreated. Kayexalate is a cation-exchange resin frequently used to treat this condition. Although rare, there is a known relationship between kayexalate administration and bowel necrosis and it is therefore important to consider this in a patient with abdominal pain who has been treated with oral kayexalate [1,2]. We present a case of a surgical oncology patient who developed spontaneous bowel perforation in the setting of kayexalate administration.

Case Report

The patient is a 60 year old male with past medical history significant for hypertension, hyperlipidemia, diabetes mellitus type II requiring insulin for glucose control and complicated by diabetic nephropathy (baseline creatinine 1.0), congestive heart failure with ejection fraction 30-40%, non-obstructive coronary lesions, moderate pulmonary hypertension and locally advanced left renal cell carcinoma (14cm mass causing renal vein thrombosis and retroperitoneal lymphadenopathy). The patient was not a candidate for neoadjuvant chemotherapy given his multiple medical comorbidities.

He underwent a left radical nephrectomy with regional lymphadenectomy with significant intra-op findings of left colon ischemia requiring left segmental colectomy with primary anastomosis. His postoperative course was significant for severe sepsis requiring initiation of vasopressor support and piperacillin- tazobactam, new onset atrial fibrillation requiring amiodarone, and acute kidney injury resulting in hyperkalemia. He was initially treated in the post-anesthesia care unit for hypotension with crystalloid, albumin and low dose phenylephrine which was weaned off over several hours. The patient was subsequently transferred to the ward. Hyperkalemia was treated with oral kayexalate 15 grams, of which the patient received six doses over the course of postoperative days #3-5 on a six hourly dosing regimen. On postoperative day #7, the patient developed acute abdominal pain and was found to have feculent output from the surgical drains. He was taken back to the operating room for exploratory laparotomy, left colectomy, transverse colostomy and mucous fistula. Postoperatively, he had continued vasopressor requirement with norepinephrine and vasopressin, he remained intubated and required intensive care unit admission. His antibiotic coverage was broadened to vancomycin, meropenem, and micafungin. Pathology of the left colon specimen revealed transmural necro-inflammation, exudative serositis and serosal fibrosis, as well as basophilic crystalloid particles consistent with kayexalate at the site of perforation, which was proximal to the prior viable-appearing anastomosis (Figure 1). Thus, a diagnosis of kayexalate-induced colon ischemia and necrosis was made.

The patient had improvement in his clinical status, was weaned off vasopressor and ventilatory support, demonstrated improvement in his renal function and cardiac function with ejection fraction to 52% and he was discharged from the intensive care unit on post-operative day #6 to the ward, then discharged home with physical and occupational therapy services on post-operative day #19 . The remainder of his course has been unremarkable.

Discussion

Kayexalate is a cation-exchange resin which was first approved by the Food & Drug Administration in 1958 and has since been widely used to treat hyperkalemia [3]. Sorbitol is an osmotic laxative which historically has been added to kayexalate formulations to reduce the incidence of constipation, however there is a well-documented association with kayexalate- sorbitol and bowel necrosis [4,5]. In 2006, the Food and Drug Administration issued a black box warning on kayexalate-sorbitol products, and this formulation has subsequently been removed from the market over the last 10 years [4,5].

Despite the removal of sorbitol from most kayexalate formulations however, there have been numerous case reports of kayexalate administration and bowel necrosis. The incidence is thought to be 0.27% overall, and up to 1.8% during the postoperative period [2,3,6]. There have also been multiple case reports of upper gastrointestinal ulceration due to oral kayexalate administration, although none of these cases have required surgical intervention [7]. The symptoms of intestinal injury have been documented to occur between 3 hours and 11 days following the administration of kayexalate, and mortality from this complication is >30% in cases with gastrointestinal injury [3,5].

Kayexalate can be administered orally or rectally, and works by exchanging its bound sodium with potassium in the colon to promote potassium excretion in stool. Its effect is seen within hours to days, and thus it is not indicated for use as sole therapy in severe hyperkalemia. Although the mechanism of kayexalate induced bowel necrosis is unknown, one suspected mechanism involves the elevated renin levels seen in patients with renal failure who develop hyperkalemia. Renin activates angiotensin II which causes splanchnic vasoconstriction and can predispose the colon to non-occlusive ischemia, especially following dramatic electrolyte and fluid shifts [8]. Norepinephrine, the initial vasopressor indicated in septic shock, is also known to reduce the splanchnic blood flow and this can worsen intestinal vasoconstriction. However, the bowel necrosis and perforation described in cases of kayexalate administration is distinguished from ischemic necrosis by the pathological presence of kayexalate crystals in the bowel wall. Basophilic crystals with a mosaic pattern on Hematoxylin & Eosin stain is pathognomic for the presence of kayexalate.

We present this case to raise clinical suspicion of bowel necrosis and perforation in a patient with abdominal pain, particularly in a surgical oncology patient where this complication has been less frequently documented, after the administration of oral or rectal kayexalate [9,10]. Early diagnosis and prompt surgical intervention is critically important in this rare yet devastating complication of kayexalate administration due to the significant morbidity and mortality associated with this condition. In addition, we recommend the use of alternative treatment strategies for hyperkalemia, including insulin-glucose, diuretics, calcium, bicarbonate, inhaled beta-adrenergic agonists and emergent dialysis in severe, life-threatening hyperkalemia as these are safer and more efficacious therapies when implemented in a timely manner.

Conflict of Interest

We have no financial interest or any conflict of interest.

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[juniperpublishers-gjorm]

Management of A Chyluria: About A Case and Review of The Literature

Authored by: Nabil Jakhlal*

Summary

Chyluria is the passage of chyle in the urine. The cause seems to be the rupture of retroperitoneal lymphatics into the pyelocaliceal system, giving urine a milky appearance. This condition, if left untreated, leads to significant morbidity. We present a case of bilateral chyluria treated by transperitoneal laparoscopic nephrolysis and discuss at the same time the epidemiological, pathophysiological, diagnostic and therapeutic characteristics of chyluria.

Keywords: Chyluria; Povidone iodine; sclerotherapy; laparoscopy; Retrograde pyelography; Lymph; Urine; Pyelocaliceal system; Haemato-chyluria; Renal colic; Cystoscopy; Hematuria; Wucheriabancrofti; Thoracic duct; Genitourinary tract; Lymphangiectasis; Lymphaticourinary fistula; Spontaneous remissions; Exacerbations; Urinary tract infections; Immunosuppression; Lipuria

Abbreviations RGP: Retrograde Pyelography

Introduction

Chyluria is the passage of the lymph in the urine. It appears to be secondary to the rupture of the retroperitoneal lymphatic vessels in the pyelocaliceal system, giving the urine a milky appearance. This condition, if left untreated, causes significant morbidity due to haemato-chyluria, recurrent renal colic, acute urinary retention, nutritional problems due to protein loss and resulting immunosuppression due to lymphocyturia. Chyluria can be classified into mild, moderate or severe.

Its treatment comprises 3 components depending on the severity of the disease: conservative medical treatment, sclerotherapy by intrarenal pelvic instillation of sclerosing agents and surgical treatment.In our work, we present a case of bilateral chyluria treated by transperitoneal laparoscopic nephrolysis and at the same time discuss the epidemiological, physiopathological, diagnostic and therapeutic characteristics of chyluria.

Observation

A 77-years-old patient from Martinique who has a history of gastric ulcer with a left inguinal hernia, admitted to our formation for the management of chronic chyluria complicated by acute urinary retention. Urine cytology was inflammatory with a negative parasitic assessment. Uroscan was normal. The cystoscopy showed very turbid urine without being able to specify the side reached. Complement with RGP revealed multiple anastomoses between the lymphatics of the left kidney and the urinary tract (Figure 1A). We opted for a transperitoneal laparoscopic with left-lymphatic disconnection. The evolution was marked by a recurrence of chyluria 6 months later. A new cystoscopy and RGP revealed a good surgical result for the left side Figure 1B with appearance of communication between the right upper urinary tract and the retroperitoneal lymphatics (Figure 2). We proceeded in the same way for the right side as the left side (a transperitoneal laparoscopic reno-lymphatic disconnection) with good clinical evolution.

Discussion

Chyluria is the consequence of the passage of the lymph in the urine giving them a milky white appearance (or milk - strawberry if hematuria associated with it) because of its high content of chylomicrons[1]. Chyluria is a benign clinical condition prevalent in South East Asia like China, India, Japan, Taiwanand parts of Africa, Australia and South America [2]. The aetiology of chyluria can be classified as parasitic and non-parasitic. Parasitic infestation by Wucheriabancroftiinfestation is responsible for >95% of parasitic chyluria in India. It occurs due to a blockage of the major retroperitoneal lymphatics and thoracic duct by the mature parasite. This leads to retrograde flow of lymph from the gut and pelvis to the lumen of the genitourinary tract, lymphangiectasis and subsequent development of urinary fistulae [3]. The most location of lymphaticourinary fistula is at the caliceal fornix but can also occur at the level of the ureter or urinary bladder [3,4]. This disease is characterized by spontaneous remissions and exacerbations. Among non-filarial chyluria, congenital causes, thoracic duct injuries, thoracic duct obstruction due to tumors, pregnancy, abdominal surgery are the most common causes [5].

The symptoms of chyluria are renal colic due to milky white urine with clots, dysuria, urinary retention, hematuria, and urinary tract infections. In some severe forms, the disease can lead to significant weight loss, malnutrition, hypoproteinemia and immunosuppression.Investigation of chyluria includes chemical and parasitic urinary testing for microfilariae, evaluation of renal function and nutritional status, cystoscopy and RGP in the first place. Cystoscopy performed best post-prandial after a high fat intake allows to specify the side achieved by objectifying the issue of milky urine through the meatus. The RGP can visualize opacification of paracaliceal lymphatics by reflux of the contrast product. The lymphography, although not allowing to specify the exact seat of the communication and abandoned by most authors, allows in some cases to make a surgical choice of the side to be treated first.The differential diagnosis will be with pyuria, phosphaturia or lipuria. In the latter event, the presence of large fat globules and the absence of fibrin redress the diagnosis. The absorption of 100 grams of Sudan III and 10 grams of butter gives the urine a characteristic bright orange color.

Chyluria can be classified according to its severity into three grades: mild (intermittent milky urine, no clots, no weight loss, a single calyx involved on RGP), moderate (intermittent or continuous milky urine with occasional clots, no weight loss, two calyces involved on RGP) and severe (continuous milky urine with clots, weight loss, most of the calyces involved on RGP) [6]. The therapeutic management of a patient with chyluria depends on the severity of the disease. Minimal and moderate cases of chyluria may be conservative, including diet modification and anti-filarial drugs [7,8]. Retrograde renal pelvic instillation of sclerosing agents has become the most common form of treatment for chyluria [9]. Its mechanism of action is to induce an inflammatory reaction, a chemical lymphangitis with subsequent closure of pyelo-lymphatic fistulas by fibrosis [9]. Different types of sclerosing agents were used: 1-3% silver nitrate, 1-25% sodium iodide, 10-25% potassium bromide, 50% dextrose, 76% Urograffin, and 22-25% hypertonic saline. Silver nitrate was one of the most important sclerosing agents used for many years; however, its use has been restricted because of its multiple side effects, such as interstitial nephritis, ureteral stenosis, papillary necrosis, renal failure, and even death [9,10].

Many authors have described the use of Povidone iodine as a sclerosing agent in the treatment of chyluria because of its high efficacy reaching 81 to 100% with a recurrence rate of 5 to 17% [11-14], its antibacterial properties, its availability and its minimal side effects [11,12,15]. Povidone iodine as a sclerosing agent for the treatment of chyluria has been used either alone or in combination with other agents, and also as a single or multiple instillations[12,13,16]. However, there is no standard protocol defined to describe the optimal dose, duration and number of instillations.

If chyluria is more severe or persistent, more radical therapeutic measures should be taken such as lympho-venous disconnection surgery, or nephrectomy and autotransplantation in very severe cases [17]. Renal-lymphatic surgical disconnection seems to be accepted by most authors as the standard surgical treatment giving a satisfactory success rate (98%) and lasting long-term results [18,19]. The commonly described technique includes nephrolympholysis, ureterolympholysis, renal hilar lymphatic vessels stripping and fasciectomy until the kidney is retained only by the renal vessels and the ureter. This poses a risk of nephroptosis and renal torsion, which is prevented by nephropexy at the end [1,8,20-22]. This procedure can be performed by open surgery or laparoscopy. Retroperitoneal renolymphatic disconnection provides the same clinical outcome as open surgery with minimal invasion, sparing operative time, less blood loss, less postoperative drainage, and faster recovery [6,23-25].

Conclusion

The treatment of chronic chyluria is complex. Its medical treatment is most often insufficiant and the reno-lymphatic disconnection remains the reference treatment. Sclerotherapy is an effective and less invasive alternative to surgical treatment. The choice of the sclerosing agent is now in favor of the use of Povidone iodine which has an equivalent efficiency to silver nitrate but with fewer complications and simpler preparation. The effectiveness of this treatment must be evaluated in the long term.

[drrajinderuro-blog]

Kidney Cancer Treatment Options

Kidney cancer

Renal adenocarcinoma is the most common type of tumour in the kidney. The primary kidney cancer treatment in Delhi is surgery. A large percentage of them are now diagnosed incidentally, which allows in many cases to make a conservative treatment of the renal unit through partial surgery. During the last years, new technologies have been incorporated in its treatment, with lower morbidity, shorter hospital stay, and the same oncological safety. The procedures and techniques that urologist in Delhi uses are the following:

Advanced     imaging techniques for diagnosis (Helical CT with "3D"     volumetric reconstruction, Uro-NMR, digital angiography, etc.)

Conventional     and minimally invasive surgical techniques:

Open     nephrectomy, radical and partial robotic onco surgery in     Delhi

Kidney     Tumour with Venous Thrombus: Radical nephrectomy with thrombectomy

Percutaneous     and laparoscopic ablation

What is a kidney tumour?

A kidney tumour is an abnormal growth inside the kidney. Often the terms "mass", "injury" and "tumour" are used as synonyms. Tumours can be benign or malignant (cancer). The most common kidney injury is the presence of a fluid-filled area called a cyst. Simple cysts are benign and look typical in imaging studies. They do not progress to cancer and usually do not require follow-up or treatment. Solid kidney tumours may be benign, but in more than 80 percent of cases, they are malignant.

What statistical data are available about kidney cancer?

In India, it accounts for 5 percent of all cancers. Kidney cancer is more common in men and is usually diagnosed between 50 and 70 years of age. The most common kidney cancer is called renal cell carcinoma.

What risk factors are associated with kidney cancer?

The following associations may increase the risk of developing kidney cancer:

Smoke

Family history     of kidney cancer

Polycystic     kidney disease

Chronic     kidney failure, dialysis, or both

Von     Hippel-Lindau disease

Tuberous     sclerosis

Exposure     to asbestos, blast furnaces and furnaces used in the iron and steel     industry

What are the symptoms of kidney cancer?

Many kidney tumours do not produce symptoms, but they can be detected accidentally during the evaluation by some other unrelated problem. Compression or invasion of neighbouring structures can cause pain (in the flank, abdomen or back), the presence of a palpable mass and blood in the urine (microscopic or visible to the naked eye). If cancer spreads (metastasis) beyond the kidney, the symptoms will depend on the affected organ. In some cases, the cancer causes associated clinical or laboratory changes called paraneoplastic syndrome. This syndrome is observed in approximately 30 percent of patients with kidney cancer and can occur at any stage, even those early limited to the kidney.

How is kidney cancer diagnosed?

Unfortunately, there are no blood or urine tests that can directly detect the presence of a kidney tumour. When a kidney tumour is suspected, an imaging study is done. The first study is usually an ultrasound or a computed tomography (CT) scan.

What are the treatment options for tumours that appear to be confined to the kidney?

When the tumour appears to be confined to the kidney ("localized" tumour), there are three main options of kidney cancer treatment in Delhi: tumour resection, tumour ablation, and surveillance. The chemotherapy, the hormone treatment, and radiotherapy are not effective for kidney cancer treatments.

Resection of the tumour

Tumour resection is considered the standard mode of treatment for most patients and is achieved through surgery: nephrectomy. A radical nephrectomy is the surgical resection of everything within Gerota's fascia, including the entire kidney. Partial nephrectomy is the surgical resection of part of the kidney (in this case, the part that contains the tumour).

The goal of partial nephrectomy is to resect an entire tumour by the best urologist in Delhi while preserving as much normal kidney tissue as possible. Renal tissue that is preserved can avoid the need for dialysis if further kidney damage occurs later. It is possible to perform the nephrectomy through a traditional incision (open surgery) or with minimally invasive techniques (laparoscopic surgery).

When it is not possible to safely resect the tumour with a partial nephrectomy, radical nephrectomy is performed. If you choose to have a partial nephrectomy, there is always a risk that you need to perform a radical nephrectomy.

Tumour ablation

Tumour ablation destroys the tumour without surgically removing it. Examples of different technologies that can be applied for ablation include cryotherapy, radiofrequency interstitial ablation, high-intensity localized ultrasound (HIFU), microwave thermotherapy, and laser coagulation. Ablation can be achieved during access through robotic onco surgery in Delhi or percutaneously (through the skin).

Because ablation of a kidney tumour is a relatively new procedure, the long-term results are not yet known. However, ablation may be less invasive than a nephrectomy and may be useful in patients who cannot tolerate more extensive surgeries.

Embolization

This is not a standard treatment option but can be considered in patients who cannot tolerate tumour resection or ablation. Cancer surgeon in Delhi considered it as a coadjutant treatment to standard forms of treatment, especially when the tumour presents active bleeding.

Embolization can stop bleeding and allows the uro oncologist in Delhi to stabilize the patient before surgery.