Kidney DisordersNo other internal organ lends itself so readily to diagnostic study as does the kidney. The techniques of investigation permit direct X ray of all its excretory channels, a complete study of its blood supply, both arteries and veins, and a body section X-ray method for viewing each level of the kidney substance under special magnification techniques. Manipulation techniques allow for the direct insertion of a catheter into the kidney through the external urinary channel.
The diagnostic concepts are simple and uncomplicated and allow for high accuracy in diagnosis. One is based on giving the patient an X-ray-visible material that will be conveyed along with the urine so that this pathway is visualized. The manipulative techniques involve retrograde instrumentation from where the urine is voided to where it is formed. These diagnostic studies, for the most part, can be performed under local anesthesia, so there is no disability thereafter and minimal loss of time. The so called kidney diagnostic work up can usually be completed within forty eight hours of presentation of symptoms and on an ambulatory basis. The diagnostic accuracy approaches 90 percent.
Kidney disease involves all ages, from the newborn whose organ may be malformed, the young child who may have a tumor, the young woman with kidney infection, the middle aged man with a stone, the matron who may have cancer, to the old man whose organ shows the effect of long standing prostatic obstruction.
Why do you want the urine collected in this particular way? Exactly what do you do with the specimen?The urine is collected as a morning specimen in a special bottle so that there will be no contaminants. It is examined for abnormal constituents such as blood, pus, bacteria and other microorganisms, stone material and proteins. In cases of infection the laboratory will determine the exact types of bacteria present and the antibiotics to which they are susceptible.
Since the urine shows that I have a urinary injection, why don't you just give me antibiotics and let it go at that? Why do I need all these studies?Urinary infections, as diagnosed by finding pus in the urine, may be the result of obstruction or deformity in the urinary tract. If this is the case, the infections will recur and destroy functioning tissue. Therefore, one should establish the basis for this infection (termed pyelitis or pyelonephritis). These studies will show such abnormalities and suggest how they should be treated to avoid further infection and its attendant kidney damage. If the studies are normal, the infection should clear up without residual damage and without recurrent infections. This is the intelligent diagnostic approach. We can treat infections properly only when we know their cause.
What is the significance of blood in the urine?This symptom always requires investigation. What causes it need not necessarily be very serious. But this symptom should never be overlooked with the false hope that "it will go away by itself." The blood can come from infection, tumors, injuries or stones anywhere in the urinary tract. It can occur in patients who have blood disease or who are taking anticoagulants for vein or cardiac disease. It can also be seen in a child with acute nephritis or in a bride as a honeymoon cystitis. However, because blood in the urine may be the early sign of a tumor of the urinary tract, its investigation is mandatory in every case.
Why do you do these blood tests if my problem is on the kidney?The kidney is the principal organ that determines the amount of certain constituents in the blood, especially urea and creatinine. If these blood components are raised above the normal level, there is usually an impairment in renal function. In the vernacular this is referred to as uremic poisoning. Other blood tests wil show whether or not there is anemia or infection. These studies supply a great deal of important information.
What can you learn about my kidneys from the intravenous pyelogram (IVP) X-ray examination? Is there any risk associated with this type of examination?The examination is virtually without risk except in certain allergic individuals. Such individuals should have sensitivity tests before the contrast material is injected. The examination offers some indication of kidney function and an exact image of its entire collecting system and of its drainage into the bladder. Many kidney diseases can be accurately diagnosed by this method alone. Several films are exposed. The examination, which is completely painless, takes 45 to 90 minutes, and you may return to full activities immediately.
What is cystoscopy? Is it painful?Cystoscopy literally means "looking into the bladder." The cystoscope is an instrument which contains a light, a lens, and an irrigating fluid system. Under sterile conditions it is inserted into the urinary channel, and the interior of the bladder can be completely seen. The procedure can be done under local anesthesia with local applications of sensation deadening drugs or done under any form of general anesthesia. In either case it should be completely painless. If well performed, no patient is reluctant to have it done a second time. If the anesthesia is carelessly administered, the patient, especially the male, may remember it with horror. It need not be so and should not be so.
What is the value of cystoscopy?Two things are gained from this examination. First, it will clearly visualize diseases of the bladder such as prostatic obstruction, stone, tumor or infection. Each of these can be definitely diagnosed. Second, abnormal tissues may be removed for microscopic examination. This procedure also provides the method for introducing catheters into one or both ureters and kidneys for further diagnosis or treatment.
Why do you want to get an X ray of my kidney blood vessels?This X ray has come to be the most accurate way of diagnosing various growths and abnormalities of the kidney and its surrounding tissues. It is usually sufficiently accurate to differentiate between kidney cysts, infections, cancers and congenital and acquired obstructive abnormalities.
How is this arteriogram done? Is it a risky procedure?The examination is done in the hospital under secondto second control. An anesthetic is injected into the thigh area, and except for this needle stick the procedure is completely painless. A special catheter is passed from the thigh artery into the kidney blood vessels, and the injection of certain materials and rapid movie picture filming allow a complete demonstration of the arteries and veins of the area. No procedure where an artery is punctured is completely without risk. There can be bleeding and injury to the artery; this occurs relatively infrequently. In the majority of patients the advantages to be gained by this procedure outweigh the risks. However, each case has to be evaluated individually.
What are the common kidney abnormalities that are due to congenital (inborn) defects?There are many possible congenital defects. Frequently more than one is present. When there are kidney anomalies, the doctor is always alert to abnormalities in other organs. A kidney may be absent, situated in the wrong place or abnormally shaped; there may be double kidneys, blocked kidneys, an undeveloped kidney or cysts in both kidneys. There is no satisfactory way of treating some of these abnormalities, while others require no treatment. All methods are directed at preserving kidney function.
Is there any advantage for the child of knowing the exact defect? Is this purely a diagnostic study?The value of knowing precisely is that some of these abnormalities may be surgically corrected so that normal function is restored and unrelenting disease prevented. The surgeon always wants to preserve as much functioning kidney tissue as possible. If the condition cannot be surgically corrected, at least certain precautions can be suggested and a knowledge of salvage possibilities considered for the future. The hopeless situation or the limited life span can also be discussed with those who should know about it.
Causes of Kidney Disease
How do you know this is tuberculosis of the kidney?The X ray distortion of the kidney structure suggests this. The diagnosis is definitely established if the injection of the patient's urine produces tuberculosis in a guinea Pig.
What is the treatment for kidney tuberculosis? Is surgery required? Will I have to go to a sanatorium?The primary treatment is by drugs, the prolonged use of so called combined therapy. A combination of three different drugs is taken daily. The treatment is continued for at least six or twelve months after the urine is shown to be free of the tuberculosis germ. Such patients must be periodically evaluated for the rest of their lives. This disease can be cured. Sanatorium treatment is rarely required. Surgery is done only for an advanced disease with such complications as extensive scarring, narrowing, contracture or total destruction of a part of the urinary apparatus.
What exactly do you mean by the statement that this is an enlarged kidney with a mass in it?The X ray shows that there is a mass, a lump, a "tumor," an abnormality in the kidney substance. There is no question about this. These masses are never normal. An enlarged kidney is not always due to cancer; it can be due to a cyst, obstruction or chronic infection. Rarely can these tumors be a simple overgrowth of the kidney tissues, in which case they are benign. If a benign tumor is removed, it will not ordinarily spread or recur or cause further difficulties. However, in this instance the arteriogram shows that the blood vessels in this area are abnormal, which usually indicates a cancer of the kidney.
In spite of all these diagnostic measures, it sometimes is still not possible to differentiate between certain kinds of kidney infection, benign tumors, and cancer either preoperatively or even at the operating table. Sometimes it is enough to know and to act on the information that the organ is so damaged that its removal is the only appropriate measure. The diagnosis is then established by microscopic examination of tissue that has been removed.