Kidney Cancer: Symptoms, Treatment, Diagnosis – NU Hospitals

What is the role of Kidneys in our body?
The kidneys are a matched pair of vital organs located underneath your liver and stomach and near your backbone on either side. They help remove wastes from the body by making urine. They do this by filtering urea, salt and other substances from the blood as it flows through the kidneys.  The kidneys serve also as glands that manufacture and secrete a variety of hormones.

What are the types of kidney tumors?
A kidney tumor is an abnormal growth within the kidney. Tumors may be benign or malignant.

Benign tumors (non-cancerous) remain localized and usually do not spread or threaten one’s life. The most common kidney lesion seen on ultrasound is fluid filled area called renal cyst. Simple cysts are benign and has typical appearance on ultrasound studies and usually don’t require any treatment.

Malignant tumors are cancers. They can invade and destroy nearby tissues and organs or spread to other parts of the body by way of the bloodstream or lymphatic system. More than 80% of solid renal lesions are cancerous.

How common are malignant renal tumors?
It accounts for 2% to 3% of all adult malignant neo­plasms. The typical presentation is in the sixth and seventh decades of life. Male-to-female pre­dominance of 3:2.

What are the risk factors associated with kidney cancer?
Smoking
Hypertension
Obesity
Family history of kidney cancer
Chronic kidney failure and/or dialysis
Diet with high fat
Certain genetic diseases involving kidneys (Von Hippel-Lindau syndrome, tuberous sclerosis)

Are there any symptoms related to kidney cancer?
Today up to 50 % of new kidney tumors are detected incidentally during routine health check or during evaluation for some unrelated problem. Symptoms of kidney cancer are blood in the urine, lump or mass in the abdomen, and pain in the side. If tumors spread beyond kidney, patient may present with fatigue, loss of appetite, weight loss and anemia.

How is Kidney Cancer diagnosed?
Diagnosis begins with a physical examination by your doctor. Diagnosis is usually first made based on Ultrasound study and later confirmed by Computed Tomography of the abdomen. Your doctor will perform other tests that will tell him whether the cancer has spread beyond the kidney or not. These include Chest x-ray, radioisotope bone scan (if the patient has bone pain, recent bone fractures, or certain abnormalities of blood tests).

What are the different stages?
Based on all investigations findings your doctor will clinically stage the tumor. The factors considered for staging are the size of the tumor (less than 4 cm, 4-7 cm, 7-10 cm or more than 10 cm), if it is confined to kidney, spread to the renal veins or to surrounding tissues and organs or distant organs.

What are the treatment options?
Your medical history, general health, the size, location of the cancer and many other factors are considered in determining the treatment needed.

Surgery: Is the standard treatment for most cases of adult kidney cancers that have not spread to distant areas of the body. Based on location, size your doctor will decide if only a part of the kidney (partial nephrectomy) or entire kidney needs to be removed (radical nephrectomy). This operation can be done by traditional open technique or by key hole incisions (laparoscopic), and this will be decided based on CT scan and technical accessibility of the tumor. The goal of partial nephrectomy is to remove the entire tumor while preserving as much normal kidney tissue as possible.

Immunotherapy: This group of drugs stimulates your immune system to attack cancer. These drugs are used in patients where the tumor has spread beyond the kidney to other organs. But it has shown some decrease in tumor size in only 20 % patients. These drugs are given intravenously either before or after nephrectomy.

Targeted Agents: These drugs cause the vessels supplying the tumor to regress. It can slow the progress of kidney cancer and allow patients to live longer. These drugs are taken orally but they can be associated with side effects including fatigue, hypertension, and skin problems. But most patients are able to tolerate these drugs fairly well and appear to benefit from them. Like immunotherapy, these drugs can be used either before or after nephrectomy. The other drawback is these drugs are expensive at present.

When will I know the final report?
The kidney/tumor that is removed will be sent for pathological examination and report should be available in 1 week time. With this report the doctor will pathologically stage your disease and advice accordingly.

Is there a need for follow up?
Yes. To look for any local or distant recurrence and care of remaining kidney. The frequency of follow up will be based on stage and tumor characteristics.

Will the kidney function deteriorate after this surgery?

When one kidney or part of a kidney is removed, the remaining functional kidney tissue usually works sufficiently to avoid problems, if there is normal kidney on the other side. In fact, people can live a normal life with only one functioning kidney. Routine follow up of kidney function is recommended. Some medical conditions, such as high blood pressure (hypertension), diabetes, high cholesterol and obesity, have the potential to cause deterioration of kidney function. Treatment of these conditions may prevent kidney damage. Therefore, it is important that you comply with Nephrologist supervised treatment of these conditions.

For More Info: http://www.nuhospitals.com/blog/kidney-cancer/

Kidney Transplantation Surgery

       Kidney (renal) transplantation is a surgical procedure in which healthy kidney from a person (donor) is removed and placed in a patient (recipient) with irreversible advanced kidney disease (end stage renal disease; ESRD)

Types Of Kidney Transplantation:
Kidney transplantation is classified into deceased donor transplantation or living donor transplantation depending on the source of the donor organ.

Can I undergo living unrelated donor transplantation?
Living unrelated donor transplantation is not permitted by law; it is also unethical as it is associated with paid donation.

Who are the patients for whom transplantation cannot be done?
Patients with kidney disease that invariably recurs and damages the transplanted kidney (graft), recently diagnosed cancer, positive cross match (see below) and active infection cannot undergo transplantation.


Who can be a voluntary kidney donor for living donor transplantation?

Parents, children, siblings, grandparents and spouse can be voluntary kidney donors if their age is between 18 to 60 years (upper age limit can be relaxed in demanding situations).

Blood group of the donor should be compatible (well suited) with that of the recipient.

The donor should be free from long standing ailments that can affect kidneys in the course of the illness (diabetes mellitus, hypertension etc.) and should have two healthy normal functioning kidneys. They should not have infection with blood borne viruses (Hepatitis B, Hepatitis C and Human Immunodeficiency Virus infection) and they should be psychologically stable to make a decision on kidney donation without coercion.

What are the tests done for the donor?

Apart from the evaluation for the above mentioned issues, tests will be done to make sure that there are no illnesses affecting other major organs. Assessment of individual kidney function by radioisotope renogram (a scanning test done following intravenous injection of radioisotope), tissue typing (blood collected from the donor and the recipient are tested for the degree of tissue level compatibility) and computed tomography (CT) angiography (contrast material is injected intravenously to see clearly the blood supply of the kidneys; location and branching of kidney blood vessels will help in surgical plan) are the other tests required for donor evaluation.

What are the risks involved in kidney donation?

There is no increased risk of death or kidney disease in living donors in the long run. The donor is advised to have annual medical checkup to ensure proper care of single functioning kidney.

What tests should be done for the recipient?

Apart from psychological evaluation and tissue typing, the recipient should undergo evaluation for a) the cause of the kidney disease if it is possible (to assess the possibility for recurrence of the disease in the graft and the timing of transplantation), b) lower urinary tract to rule out abnormal urinary outflow (they should be taken care before transplantation as they can predispose to post transplant urinary tract infection), c) blood borne viruses – if positive for viruses, they should undergo treatment for these viruses before transplantation and d) heart disease with coronary angiogram especially in patients who have diabetes mellitus and prior heart disease.

How much time will it take to complete donor and recipient evaluation?

Approximately two weeks.

What are the administrative procedures associated with living donor transplantation?

The donor should sign an affidavit stating that kidney donation is voluntary and not by force (to be attested by notary public). You should get an approval letter for undergoing transplantation from The Authorization Committee of Organ Transplantation, Karnataka. Our Hospital front office in charge will guide you in getting all these procedures done. If you are not a native of Karnataka, you should get No Objection Certificate from your native state Committee before submission of papers to the local Committee.

What should I do to get the approval letter from the Authorization Committee of Organ Transplantation?

You should submit copies of all investigation reports along with a request form for kidney transplantation to The Authorization Committee of Organ Transplantation once all the tests are completed. The Committee will issue approval letter after verification of the documents (especially proof of relationship and residence) in two to three weeks’ time from the date of submission.

What are the procedures after approval from the Committee?

Date will be fixed for kidney transplantation if you do not have any active infection or other problem. Final tissue cross match will be done using donor’s and recipient’s blood 2 days prior to scheduled date of transplantation to make sure that there are no preformed factors in the recipient’s blood that can damage the graft. If the cross match is negative, you will be admitted that day evening and the donor, the next day noon. Immunosuppressive medications will be started and a session of hemodialysis will be done the day before transplantation

What will be done during renal transplantation?

The recipient will undergo central vein catheter insertion (to monitor central venous pressure), urinary catheter insertion (to monitor urine output) and catheter insertion into the back (for injecting pain relieving agents) prior to surgery in the Operating Room (OR). The donor will undergo urinary catheter insertion (to monitor urine output) and catheter insertion into the back (for injecting pain relieving agents) at the same time.

The kidney will be removed from the donor under anesthesia and brought to the recipient table. By that time, space will be created in the abdomen of the recipient in the area above the thigh to keep the new kidney. Then the donor kidney will be connected to the recipient blood vessels.

When will the transplanted kidney start working?

In almost all patients (95%), the graft will start its function immediately as evidenced by brisk urine output and progressive decline in serum creatinine (a blood marker for kidney function). Immediate function of the graft does not mean that everything will be all right thereafter. Kidney function may decline any time in the post transplant period (immediate and late) and that is why, constant and regular monitoring of kidney function using blood and urine tests is needed.

What will you do if the graft does not function immediately?

The cause for defective graft function will be analyzed by blood, urine and ultrasound tests and appropriate corrective action will be taken to improve graft function. In that process, additional procedures like graft exploration in OR and graft biopsy may be required and you may continue to require dialysis till there is improvement in graft function.

There is a rare possibility (1%) that the graft may not function at all (because of complications in the blood vessels or severe rejection) and you will have to continue dialysis till you undergo transplantation again. Such grafts may require removal in OR to avoid serious life threatening complications like rupture of blood vessels or the graft itself.

Will I require dialysis again after kidney transplantation?

But for the above mentioned situations, dialysis will not be required post transplantation.

When will the catheters be removed?

The catheters will be removed in three to four days’ time for the donor and in a week’s time for the recipient (if there is no complication in the postoperative period).

When will the donor and I be discharged after surgery?

The donor will be discharged on fifth day and you, on seventh or eighth day (if there is no major complication in the postoperative period).

Will you remove my diseased kidneys?

The diseased kidneys will be removed only if they are seriously infected or the cause of severe hypertension or massive bleeding.

For More Info: http://www.nuhospitals.com/renal-kidney-transplant/