What is the causes of kidney disease? Can kidney disease get better?

Kidney Disorders

No 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.
The majority of kidney patients first exhibit one of five major symptoms: blood or pus in the urine, pain in the loin, presence of an abdominal tumor, signs of infection, or increased urea in the blood, which is evident in laboratory tests.

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.

What is a kidney carbuncle? 

This is a collection of pus in the kidney. It often represents a manifestation of "blood poisoning" from an infection elsewhere, such as an abscess in the skin. The disease is far less common than formerly because the primary infection can now be easily treated with antibiotics. Kidney infections that persist may go on to carbuncle formation, in which case the cause is poor drainage of an infected kidney.

How can you be so sure it is a kidney cyst? 

The intravenous X ray and arteriogram are accurate about 90 percent of the time. In the other 10 percent of cases an exploratory operation may be required for accurate diagnosis or for decompression of a huge cyst.

What is the treatment for a kidney cyst? Is there anything I should or should not do? 

The usual type of solitary kidney cyst requires no treatment. It almost never becomes infected or cancerous.

What makes the diagnosis of kidney cancer so likely? 

The intravenous X ray shows that the kidney is enlarged and its structure distorted by a space occupying mass. The arteriogram clearly demonstrates that the blood vessels to the area are altered and distorted in a pattern that is usually seen only in cancer cases. These observations make the diagnosis of cancer very likely.

What is the best way to treat cancer of the kidney? 

The best treatment will obviously depend on the specific type and sensitivity of the individual cancer. It may be best to employ a combination of surgery and radiation treatment. The surgery entails removal of the entire kidney, its contiguous growth containing area, its surrounding fatty tissues, and any associated veins. External radiation treatments are given to the tumor bed area and to the areas to which it may be expected to spread.

How does one manage with one kidney removed? What are the chances for survival if the cancer can be removed? 

If the other kidney is functioning normally, removal of the diseased kidney has no effect. Obviously, before removing one kidney it is necessary to be sure, by X ray, that the other one is functioning normally. The patient with one normal or well functioning kidney maintains a normal pattern of blood constituents and of urin tion. If the cancer can be completely removed, most adults will do very well for at least five years.

Why do some patients with cancer of the kidney do less well than others? 

There are several explanations for this. A particular cancer may be more aggressive and it may spread into the lungs by way of the major veins. In other instances the cancer may have been so "stuck" to surrounding tissues that it was not possible to remove it totally. Some of the remaining cancer cells may then continue to grow and be resistant to the effect of radiation and anticancer drugs.


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