Regular kidney tests must for diabetics, hypertensives

• Kidney failure can be a silent killer
• Those suffering from high BP and diabetes notice it only after it has failed

Not many are aware that kidney, besides removing wastes from the blood, also play a key role in controlling blood pressure (BP). That is why kidney tests are compulsory for those with hypertension (high BP). The onset of kidney failure is much more in patients with high BP coupled with diabetes.

Four kinds of kidney problems

There are four kinds of kidney problems - Kidney infection, stones, failure and tumors/cancer. Generally infections occur due to bacterial urinary infections that spread up to kidney in women. This problem can be resolved through intake of antibiotics.

Kidney stones seen in men are of different kinds and their size ranges from that of a sand particle to golf ball. Though they are not dangerous, they cause severe pain and can be treated. Problems such as diabetes, overweight and other health issues in smokers and alchoholics tend to mask kidney problems. So many realise that their kidneys have stopped functioning rather late. Therefore, kidney disease can be termed as a silent disease. Dialysis and kidney transplant are the treatments suggested for kidney failure in most cases.

Kidney tumours in infants (since the time of their birth) is often noticed in infants during their bath time and other regular medical check-ups. The symptoms are bloody urine, stomachache, fever, hunger, loss of weight and indigestion depending upon the size of the tumour. These are called Nephroblastomas or Willm’s tumor which normally appear when the children are five years old. These tumours which are more prevalent in girls than boys can be completely cured.

Renal cell carcinoma, a kind of tumour, appears with age. These cancers tend to spread to lungs and other parts. These tumours also may appear in both the kidneys. Its different sub types can be noticed in other kidney related and tests like ultrasound. The severity of this cancer increases with age. This cancer is seen in young smokers. That is why these cases are more prominent in cities like Delhi, Mumbai and Bangalore.

Smoking, alcohol, over weight and gene mutations are the main reasons for this cancer. Physical examination, blood tests, urine tests, x-ray, ultrasound, CT MRI and tests that show the calcium levels, should be done when symptoms are seen. Sometimes it might have spread to lungs, bones, even before noticing this cancer, and hence chest X-ray, bone scans also should be done.

Chemo and radio therapies are done to remove the entire kidney is done along with surgery depending upon the type of cancer. Nowadays, kidneys are removed through laparoscopic method also. There are many treatments available even for benign tumours, depending upon the size.

Three kinds of surgeries done according to stage of the tumor after surgery are:

Radical Nephrectomy: Apart from removal of kidneys, adrenal glands, lymph veins and tissues are also removed fully in this surgery which is performed in patients with big tumours.

Simple Nephrectomy (Stage 1) - Only one kidney is removed when there is kidney cancer and treated in early stages.

Partial Nephrectomy: If there is only one kidney by birth and tumor is noticed, then the kidney is removed only to that extent of the tumor. Same is the case when there are tumours in both the kidneys.

When only one kidney is removed, the patient can still leap back to normalcy within a few days after surgery. It is better and advisable to go for dialyses and if possible, kidney transplant when both kidneys are removed or the second one starts getting dysfunctional after removal of the first kidney.

Follow up care is essential even after treatment. CT scan, chest x-ray and other tests should be done regularly. While not neglecting symptoms like blood in urine, patients should abstain from smoking and alcohol.

(The doctor is MS (Gen), DNB (Surg), Mch (Surg Onco), FRCS, (Edin) Diploma in lap surg (France) Chief Surgical Oncologist, Vamsy1964@gmail.com 9848011421)