WHAT IS SIMPLE RENAL CYST? WHAT IS ITS SYMPTOMS?

Cysts are saccules filled with water. They may be monitored within different regions of the body and kidney is one of them. As cysts may not cause any symptoms; they also may cause some problems such as;

  • High blood pressure
  • Inflammation
  • Stone
  • Bleeding
  • Kidney failure

WHEN IS TREATMENT REQUIRED FOR SIMPLE RENAL CYSTS ?

Generally, it does not create any problem until diameter of 10 cm. So, treatment of such cysts is not necessary as well as they grow much. When the cysts grow over 10 cm and/or they have causes high blood pressure, inflammation and kidney failure, treatment is done.

HOW IS THE TREATMENT ARRANGED FOR SIMPLE RENAL CYST ?

The purpose of the treatment is to annihilate the pressure effect created by the cyst.

For this:

a. Percutaneous ultrasonic aspiration: A needle is inserted into the cyst with guidance of ultrasonography and cyst fluid is discharged. It is temporary but also easy method. It does not require anesthesia and may be performed within polyclinic environment.

b. Surgical: The cyst is removed by open surgery or laparoscopic techniques. It provides definite therapy. However, it requires hospitalization and is performed under anesthesia in OR environment.

WHAT IS RENAL ADENOMA, HOW IS IT TREATED?

It is the most common solid and benign tumor of the kidney. (%7-22). Becoming malignant potential increases in proportion with the size of the adenoma (over 3 cm). Therefore, it may require partial or radical nephrectomy.

WHAT IS KIDNEY ANGIOMYOLIPOMA, HOW IS IT TREATED ?

It is a benign tumor of the kidney. Angiomyolipoma is rich in fat, smooth muscle and vessel and when it is over 6 cm, it may cause lumbar pain, hematuria, hypertension and hemorrhagic shock as a result of intrerenal and perirenal hemorrhage. For problem creating conditions; urgent nephrectomy, partial or nephron protecting nephrectomy or embolization are done.

WHAT IS THE MOST COMMON MALIGN TUMOR OF THE KIDNEY?

It is also called Renal adenocarcinoma; Renal Cell Ca, Hypernephroma or Grawitz tumor. It consists of 3% of all malign tumors and 85% of malign tumors of the kidney.

WHAT ARE THE CAUSES FOR RENAL CANCER ?

Although the cause is not definite, it has been reported that genetic factors, living in developed countries (due to easier use of diagnosis methods), eating foods rich in fats and cholesterol, working in cadmium, asbestos, petrochemistry and leather industry and smoking may increase to kidney cancer.

WHAT ARE SYMPTOMS OF PROSTATE CANCER ?

It has 3 major findings which appear at late period.

1. Hematuria (bloody urination)

2. Lumbar pain

3. Mass

Besides; varicocele, hypertension, fatigue, weight loss, anemia, fever and symptoms of metastasis may be detected at further stages.

WHICH TESTS ARE USED FOR DIAGNOSIS OF KIDNEY CANCER?

Ultrasonography: Diagnosis value for solid or cystic kidney tumors is 90%. It is a diagnosis method which is required to be applied first.

Urography (DUSG-IVP): It may show the irregularity on kidney contours and collective system and renal function loss in parenchyma damage.

Computed Tomography (CT): At the same time, diagnosis for local dissemination, regional lymphadenopathy and tumor thrombus on the renal vein or vena cava, liver, spleen metastasis may be possible with CT.

Color Doppler US and Cavagraphy: It should be done for suspicious tumor thrombus detected on CT.

Renal Angiography: It may be applied for the cases where CT is not sufficient for differential diagnosis of solid tumors.

WHAT ARE TREATMENT OPTIONS FOR RENAL CANCER?

For the treatment of malign kidney tumors, 1st Surgical, 2nd embolization and 3rd Immunotherapy options are present.

WHAT ARE SURGICAL TECHNIQUES APPLIED FOR RENAL CANCER ?

Surgical treatment may be performed with open surgery and laparoscopic surgery techniques technically and following surgical methods may be applied according to the tumor type, location, size, being unilateral or bilateral, general condition of the patient and experience of the surgeon consequently;

a. radical nephrectomy

b. Nephron protecting surgery

Partial nephrectomy or tumor enucleation (tumor removal only).

WHAT IS THE TREATMENT OPTION FOR ADVANCED RENAL CANCER ?

RADIOTHERAPY:

Kidney cancer is radio-resistant (resistant to the radiation). However, it may be applied for palliative purpose.

Chemotherapy:

There is not any single or combined cytostatic agent which is significantly effective to the kidney cancer. Although many combined therapies are tried, efficiency is about 5 to 10% and short.

Immunotherapy: Single interferon or combination of interferon with vinblastine and interleukin are used recently, but results are not blissful.

WHAT IS THE SURVIVAL FOR RENAL CANCER?

While the 5 years survival is 90 to 100% for early stages, this ratio decreases to about 20% for advanced stages.

Therefore;

Routine check-ups (complete abdominal ultrasonography) are quite important. The sooner the disease is diagnosed, treatment is such easier and more successful.

WHAT ARE CAUSES FOR COLLECTING SYSTEM AND URETHER TUMORS?

As well as it has not any exact cause;

Smoking – long use of some analgesic drugs such as phenacetin – long use of a drugs called cyclophosphamide which is used for chemotherapy – chronic urinary tract infection- stones not treated for a long period – diseases that cause obstruction in urinary tract –Balkan nephropathy are among causes.

WHAT ARE SYMPTOMS OF COLLECTING SYSTEM AND URETER TUMORS?

80% PAINLESS MACROSCOPIC HEMATURIA

Nonspecific findings such as Abdominal pain- weight loss- Nausea/vomiting _ anemia may be detected.

HOW ARE RENAL COLLECTING SYSTEM AND URETER TUMORS DIAGNOSED ?

All painless hematuria cases should be approached by a concern that there is an underlying tumoral event unless otherwise is proven.

Ultrasonography (US) and/or Urography (IVP) should be performed first.

US: It may show a mass within the renal pelvis or images on enlargement on the upper side due to a mass in the ureter may be taken.

IVP: It may show a filling defect and non functioning in the kidney.

Computed Tomography (CT): It may show both renal pelvis and mass in the ureter as well as it is a test that should be preferred to show metastasis on surrounding tissues.

URETEROSCOPY is a test that may be applied to see the inner side of the ureter clearer for bleedings without undetected reason.

Furthermore: Retrograde pyelography – cytology and cystoscopy may be done.

WHAT ARE TREATMENT FOR COLLECTING SYSTEM AND URETER TUMORS ?

Nephroureterectomy (removal of the kidney + ureter + the area where the ureter enters from the bladder) is an ideal therapy.

This procedure may be performed with open surgery as well as Laparoscopic surgery.

Conservative approaches (Endoscopic resection – tumor excision and end to end anastomosis to the ureter or neocystostomy i.e.) may be tried for low grade and stage tumors. Chemotherapy and/or Radiotherapy may be tried for metastatic cases.

WHAT IS ACUTE PYELONEPHRITIS? WHAT ARE THE CAUSES?

It is an infectious and inflammatory disease that effect the renal pelvis and parenchyma. The most common infection agents are Eschericia coli, proteus and klebsiella species.

WHAT ARE PREDISPOSING CAUSES FOR ACUTE PYELONEPHRITIS?

Predisposing factors include urinary system abnormalities, obstructions, urinary system stones, metabolic disorders such as diabetes and hyperuricemia, pregnancy, analgesic addiction and foreign bodies(catheter, stent i.e.) in the urinary system.

WHAT ARE SYMPTOMS AND FINDINGS OF ACUTE PYELONEPHRITIS?

Acute pyelonephritis is an inflammatous disease. There is an acute disease picture with fatigue. General status disorder may be seen. Body temperature exceeds 38°C with shivering. A continuous, blunt pain on costovertebral region and sensitivity is detected on palpation. Nausea and vomiting accompany to this picture. Abdominal distention, rebound sensitivity, decrease on bowel sounds and subileus symptoms may even be seen. The patients also have complaints with the urine and pyuria (plenty leukocytes in the urine test).

HOW IS ACUTE PYELONEPHRITIS TREATED?

The disease is serious in general, hospitalization and bedrest are required. Blood and urine samples are taken form the patient immediately. Parenteral fluid and empirical antibiotic treatment should be started as soon as possible. The treatment started is continued for 1 week at least and until 3 days after body temperature decrease parenterally. Then oral antibiotic treatment should be given for 2 weeks more. If complicating factors are suspected during this period, they should be searched and treated.

WHAT DOES CHRONIC PYELONEPHRITIS MEAN?

WHAT IS THE MOST COMMON CAUSE?

Chronic pyelonephritis is acquired during the childhood and carried to the adulthood. Immature and developing kidneys are effected. Scar occurs on polar (upper or lower pole) regions of the kidney in particular. The scar on the parenchyma damages the structure of the calyx by pulling and dilates it. The most common cause during childhood is reflux.

WHAT ARE SYMPTOMS OF CHRONIC PYELONEPHRITIS ?

It may progress with acute infection attacks. Fever and acute pyelonephritis like picture is seen on the acute phase. If acute infection is present, it has less symptoms in general.

WHAT IS THE TREATMENT FOR CHRONIC PYELONEPHRITIS?

Treatment:

Specific treatment:

1. Medical:

Base line of the medical treatment includes eradication and prevention of the urinary system infections, long term suppressive antibiotic treatment if required.

2. Surgical:

Causes such as anatomical disorders, obstructions, stones, high grade reflux or reflux non-respondent to the medical treatment, hypertension (drug resistant, with unilateral atrophic pyelonephritis) require surgical treatment.

For surgical treatment, interventions to remove the pathology are selected primarily. If this is impossible, nephrectomy may be considered.

GENERAL PREVENTIONS: Close monitoring, control of urinary infections, early diagnosis and treatment of the complications are important. The patent should intake sufficient fluid.