Kidney clinic

The kidneys are a pair of bean shaped organs responsible for blood filtration. It also eliminates waste products from the body. The kidneys are located in the abdomenal cavity of the body and help in keeping a check on the electrolyte level in the body.

Polycystic kidney disease or PKD is a condition in which a number of cysts grow on the kidneys. The cysts are filled with fluid, and if the number or the size of the cyst increases, it can lead to kidney damage and kidney failure. 5% of kidney failures are caused by PKD. PKD does not affect only the kidneys. It can also cause the cyst to grow on other organs, such as liver, pancreas, ovaries, spleen and large bowel. The brain and the heart can also be affected by PKD. If it reaches the brain, an aneurism is caused. Heart murmurs may occur if PKD affects the heart.

Symptoms: Symptoms are visible for those in the 30 to 40 age group; however, it differs from person to person. Back pain or side pain, enlargement of the abdomen, blood in the urine, high blood pressure, and frequent bladder or kidney infections are some of the common symptoms of PKD.

Diagnosis: An ultrasound is the most dependable, affordable and non-invasive way to diagnose PKD. MRI and CT scans can be used to detect the volume of the cyst. It also helps to determine small cysts which cannot be detected by ultrasound.

Treatment: There is no specific treatment for PKD at present. But certain steps and measures can be taken to slow down the growth of the cyst and to control the symptoms.

Prevention: Keeping a check on blood pressure, use of prescribed antibiotics to treat kidney or bladder infection, restricted use of caffeine, and medications to control pain are some of the treatments for relief and for arresting the growth of the cyst. Research also shows that drinking plenty of water throughout the day can also slow down the growth of the cyst. A diet low in fat and moderate in calories is recommended.

Types: Autosomal dominant kidney disorder is a genetic disorder and is passed on to the child from the parent by dominant inheritance. It is the most common type of PKD. The symptoms are visible after the age of 30 to 40. Infantile or autosomal recessive PKD is a genetic disorder and is inherited by the child from the parent by recessive inheritance. The symptoms are visible during the early months of life or in the womb. It is a rare form of PKD and occurs in 1 out of 25,000 people. Acquired cystic kidney disease occurs due to long-term kidney damage and is linked with kidney failure and dialysis. The bleeding of the cyst causes the bleeding in the urinary system and leads to urine discolouration.

Each tiny action we commit involves the risk of a condition, disease or disorder. For instance, sneezing a bit too hard can rupture an eye vessel, or having your face right up against the wind in a moving bus can expose you to germs. Diabetes is as prevalent as common cold in every household and there is no end to the list of causes that can make you suffer from it. While regular check-ups, medications, insulin shots can help you cope, there are certain measures that if followed, can enable you to avoid the risk of secondary yet fatal diseases. Diabetic nephropathy is one such condition.

When Kidney is affected to the extent that it cannot perform its functions(like excretion of wastes in urine, filtering blood from waste, maintaining electrolyte balance,etc.) properly, it is called as Nephropathy. The reason behind kidney damage could be many, but if diabetes is the prime cause, it is known as diabetic nephropathy in medical terms.

A few features of this disorder are as follows:

1. The kidneys comprise of several small blood vessels, which perform the function of sifting waste from your blood. Diabetes at an advanced stage can impede smooth functioning of these vessels. As a result, the kidneys malfunction or a person faces kidney failure.
2. Nephropathy brings along some other health issues as well. A person's blood pressure may increase as a result, thus making him or her prone to heart attacks and strokes. Sharp rise in cholesterol and triglyceride levels has also been noticed.
3. A doctor will check for the presence of a protein called albumin in the patient's urine to know if you suffer from nephropathy or not. Other tests to determine the functioning of kidneys are - S.Creatinine, eGFR, Albumin/Creatinine Ratio (ACR), 24 Hour Urine Protein, Renal Function Tests, etc. A diabetic person should therefore go in for yearly tests.

In a given situation such as this, dialysis or kidney transplant comes to your aid. Both are done when kidney functions are irreversibly damaged. Dialysis can be of two kinds; Hemodialysis or Peritoneal dialysis. Dialysis (also called as Renal Replacement Therapy) remedies kidney damage and kidney failure by using a machine to extract salts, wastes and other fluids in excess from the blood to let your blood have a healthy composition. Dialysis should only be done under the supervision of an experienced nephrologist for best results.

Bladder cancer can be caused by a variety of factors, which include genetic factors, inheritance, drugs, chemicals, environment related factors and smoking. In fact, smoking tobacco is one of the major causes of bladder cancer around the world. The chemicals present in tobacco can irritate the bladder lining which ultimately leads to bladder cancer. Besides smoking other important environmental factors might be chemotherapy, exposure to chemicals from newspaper, dye, leather, paints industries.

Symptoms of bladder cancer are as follows:

Most often it occurs in people more than 50 years of age. It can present in different ways, but common symptoms being :

1. Painless hematuria - reddish or brownish colored urine with or without clots Increased frequency of urination Pain while passing urine .
2. Difficulty in passing urine

Diagnosis:

The diagnosis requires a proper imaging workup including ultrasound, CT scan and urine examinations. Following the initial imaging, a biopsy is required to confirm the diagnosis and stage the disease. This is done by cystoscopy under anesthesia.

Treatment Options:

Treatments for bladder cancer.depend on the stage of cancer. Broadly bladder cancers can be categorised into Non-invasive and Invasive cancers.

1. For non-invasive cancers: It requires recurrent cystoscopic surveillance and resection. For those with high risk of tumor recurrence or progression, intravesical chemotherapy or immunotherapy might be required.
2. For invasive cancers the various treatment choices are:
   1. Surgery: For localised tumor which are amenable to resection perhaps surgery is the best possible treatment. This is a major undertaking where in whole of bladder along with accessory organs is removed. The surgeon may offer choices for reconstruction between neobladder (refashioning bladder with patient's gut) or ileal conduit (fashioning a stoma over which bag can be worn to collect urine). Following surgery a regular follow up is required and the prognosis is good.
   2. Chemotherapy: This modality is reserved for patient's where surgery is not possible or they have metastatic disease (disease spread to other body parts).In this method, medications are used to target and destroy cancer cells.
   3. Radiation Therapy: This might be and option for patient's that are not suitable for surgery. Radiation therapy uses gamma rays to destroy cancer cells in the body The key to good prognosis in bladder cancers is early detection timely intervention and good follow up.

A kidney stone may not be as big as the stones in your garden, but can be quite a pain. Kidney stones are actually mineral crystals that are usually a combination of calcium and phosphates. The size of a kidney stone ranges from the size of a sugar crystal to a ping pong ball. While some kidney stones pass out of the body along with urine, others can block the urethra and become painful. 

In addition to being painful, a kidney stone can cause permanent damage to your kidneys. Since large kidney stones are usually painful, they rarely go undiagnosed. However, if a kidney stone is left untreated, it could cause the kidney to atrophy and lower the functionality of the kidney. Kidney stones that are related to an infection can also lead to chronic urinary tract infections and damage the kidney through scarring and inflammation. This could eventually lead to kidney failure.
 
Not all kidney stones need to be treated with surgery. If the kidney stone is very small, your doctor may prescribe plenty of water and medication to treat the pain. With plenty of water, you should be able to pass the stone in your urine. Ideally, you should take plenty of rest until the stone is passed. 

Larger kidney stones may need you to be hospitalized for treatment. These are:

• Extracorporeal shock wave lithotripsy (ESWL): To begin this of treatment, a painkiller is administered. Ultrasonic waves are used to determine the location of the kidney stone. Shock waves are then passed through the kidney stone to break it into smaller pieces, which can then pass out of the body through urine.
• Ureteroscopy: This is also called retrograde intrarenal surgery and is performed when the kidney stone is stuck in the ureter. A ureteroscope is passed through the urethra and bladder into the ureter. Laser energy may then be used to break the stone into smaller pieces to unblock the ureter. 
• Percutaneous nephrolithotomy (PCNL): This surgery is performed under general anesthesia.  It involves a small incision being made in the back and a nephroscope passed into the kidney through it. Laser or pneumatic energy is then used to break up the stone into smaller pieces and pull them out. 
• Open surgery: Open surgery is performed only in the case of an abnormally large stone or abnormal anatomy of the person. An incision is made in the back that allows the doctor to access the kidney and manually remove the stone. If you wish to discuss about any specific problem, you can consult a Urologist.